新型非核苷类CMV抑制剂预防allo-HSCT后CMV再激活的临床分析  

Clinical analysis of letermovir for preventing cytomegalovirus reactivation after allogeneic hematopoietic stem cell transplantation

作　　者：林湘涵 张素平[1] 李丽[1] 边志磊[1] 高思雨 范金鹏 李岩[1] 万鼎铭[1] Lin Xianghan;Zhang Suping;Li Li;Bian Zhilei;Gao Siyu;Fan Jinpeng;Li Yan;Wan Dingming(Department of Hematology,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院血液科,郑州450052

出　　处：《中华器官移植杂志》2024年第11期796-802,共7页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金面上项目(82170211)。

摘　　要：目的分析非核苷类(cytomegalovirus,CMV)抑制剂来特莫韦对异基因造血干细胞移植(allo-HSCT)后CMV再激活的有效性及安全性。方法选取2022年9月至2023年9月在郑州大学第一附属医院行allo-HSCT并应用来特莫韦预防CMV再激活的50例受者作为观察组(来特莫韦组),并通过倾向性评分匹配分析选取2021年8月至2022年8月于同一中心行allo-HSCT未服用来特莫韦的50例受者作为对照组,回顾性分析两组受者的临床资料,比较两组受者在移植后100 d内CMV再激活的发生率、总存活率、细胞植入时间和其他不良事件发生情况。生存分析采用Kaplan-Meier法进行。结果来特莫韦组中检出3例(6%)CMV再激活,对照组中检出23例(46%)CMV再激活,来特莫韦组CMV再激活发生率更低(P<0.01);移植后100 d内来特莫韦组1例死亡,总存活率98%,对照组3例死亡,总存活率94%,死亡病例的生存时间为64 d(58~81 d),两组总存活率比较,差异无统计学意义(P=0.617);两组继发性植入不良发生率分别为来特莫韦组3例(6%),对照组12例(24%),来特莫韦组继发性植入不良发生率低于对照组(P=0.023),两组在粒细胞植入时间(P=0.054)和血小板植入时间(P=0.649)方面差异无统计学意义;来特莫韦组和对照组出血性膀胱炎(hemorrhagic cystitis,HC)发生率比较,来特莫韦组低于对照组[17例(34%)比27例(54%),P=0.044],且差异有统计学意义。但两组移植后EBV感染及急性移植物抗宿主病发生率差异无统计学意义。结论非核苷类巨细胞病毒抑制剂来特莫韦可降低allo-HSCT后CMV再激活发生率,是预防CMV病、改善受者早期预后的一种安全有效的方法。ObjectiveTo observe the efficacy and safety of letermovir in preventing cytomegalovirus(CMV)reactivation after allogeneic hematopoietic stem cell transplantation(allo-HSCT).MethodFrom September 2022 to September 2023,retrospective analysis was conducted for the relevant clinical data of 50 recipients of allo-HSCT at First Affiliated Hospital of Zhengzhou University Hospital.Letermovir prophylaxis was offered for preventing cytomegalovirus(CMV)reactivation post-transplantation.They were historically compared with previous patients at the same center without letermovir prophylaxis.The incidence of CMV reactivation,overall survival rate,engraftment status and other adverse events within 100 days post-transplant were compared between two groups.Propensity score matching(PSM)was utilized for controlling confounding factors.Univariate analyses were performed with t and chi-square tests while survival analysis conducted with Kaplan-Meier method.ResultIn letermovir group,CMV reactivation was detected in 3 cases(6%)versus 23 cases(46%)in control group.Letermovir significantly reduced the incidence of post-transplant CMV reactivation(P<0.01).Within Day 100 post-transplant,there was one death in letermovir group with an overall survival rate of 98%.In control group,three deaths occurred with an overall survival rate of 94%.The median survival time of deceased cases was 64(58-81)day.No statistically significant inter-group difference existed in overall survival rate(P=0.617).In letermovir group,secondary implantation failure was observed in 3 cases(6%)and it was lower than 12 cases(24%)in control group.Statistically significant inter-group difference existed in secondary implantation failure rate(P=0.023).However,regarding timing of neutrophil engraftment(P=0.054)and platelet engraftment(P=0.649),there were no significant inter-group statistical differences.Hemorrhagic cystitis(HC)occurred in letermovir group(17 cses,34%)and control group(27cases,54%).The incidence of HC was significantly lower in letermovir group than that

关 键 词：造血干细胞移植 异基因造血干细胞移植 巨细胞病毒 

分 类 号：R457.7[医药卫生—治疗学]