Clinical Analysis Of The Risk Factors Of CMV Infection After Allo-hematopoietic Stem Ccell Transplantation

Objective:To investigate the risk factors of CMV infection in allo-hematopoietic stemcell transplantation patients.Methods:83patients (45male and38female) underwent allo-HSCT from January2012to April2013in our hospital were retrospectively analyzed. The median age was15(2-48) years old.32patients were diagnosed as aplastic anemia (AA).43patientssuffered from leukemia. Two patients were diagnosed as myelodysplastic syndrome-RCMD (MDS-RCMD). Two patients were diagnosed as lymphoblastic lymphoma/leukemia. All recipients and donors were CMV-seronegative before HSCT. All patientsaccepted myeloablative regimen without total body irradiation (TBI). In total,50patients underwent haploidentical hematopoietic stem cell transplantation (Haplo-HSCT).33patients received graft from HLA-matched donor (16had relateddonor(MRD) and17had unrelated donor(URD). SAA patients with HLA-matcheddonors acceptedfludarabine(Flu) and cyclophosphamide(CY) as conditioning regimen.While SAA patients with HLA-mismatched related donors accepted Flu, CY andbusulfan(Bu) as conditioning regimen. Leukemia patients with HLA-matched relateddonors accepted BU/CY as conditioning regimen. While leukemia patients with HLA-mismatched related donors or HLA-matched unrelated donors accepted Bu/CY plusCytarabine(Ara-C) as conditioning regimen. Lomustine (CCNU) was used to prevent central nervous system leukemia in all of the acute lymphocytic leukemia patients. Theumbilical mesenchymal stem cells were coinfused with hematopoietic stem cells. Forprophylaxis against graft-versus-host disease (GVHD), all SAA patients with an HLA-matched related donor received CSA, MTX, ATG or ALG and MSC, SAA patientswith an HLA-matched unrelated donor received MMF on the basis of the former andpatients with Haplo-HSCT received CD25on the basis of the latter. The leukemiapatients with HLA-matched related donor received CSA+MTX and others receivedCSA+MTX+MMF+ALG/ATG to prevent GVHD. Prophylaxis of viral infectionsstarted on-9day. Oral acyclovir or intravenous ganciclovir(GCV) were used accordingto different types of transplants until-2day and oral acyclovir(ACV) was given from+2day to6months. CMV-PCR was performed twice a week after neutrophils engraftment.CMV-DNA＞500copies/ml was defined as CMV viremia and preemptive therapy wasstarted with GCV or foscarnet until CMV was seronegative.Results：All patients achcieved neutrophils engraftment successfully. The median timewas19days. Platelet was engrafted successfully in70patients, while failed in13patients.68patients (81.9%) were dignosed as CMV viremia. The earliest CMVviremia happened on day23. The transplantation type, the use of in vivo T-celldepletion with ATG or ALG, MMF and the occurance of acute GVHD were risk factorsof CMV viremia (P＜0.05).63patients experienced CMV reactivation. Only2patientsdied of CMV disease (CMV pneumonia). There had been28(33.7%) patients died ofkinds of complications of HSCT till February2014.Conclusion： CMV is the most common virus infected after allo-HSCT. Type oftransplantation, T-cell-deplet, MMF and acute graft-versus-host disease are the riskfactors of CMV viremia. Antiviral chemoprophylaxis and pre-emptive therapy candecrease the incidence of CMV disease effectively.