RESUMO
Hematological cancers and non-malignant hematological disorders are biologically diverse conditions and are treated differently. We compared the pattern of EBV infections following allogeneic stem cell transplantation between the above two groups of hematological disorders. Eighty-three transplants were evaluated over a consecutive 7-year period at a single center. No difference was found in the incidence of post-transplant EBV infections between the two groups, though a higher median peak viral load was noted in the non-malignant group (P=0·04). Pre-transplant immunosuppressive therapy with antithymocyte globulin (ATG) significantly increased the risk of post-transplant EBV infections (P=0·04) in the non-malignant group patients. No significance was found for prior cytotoxic chemotherapy among the malignant group of patients. Alemtuzumab based conditioning was not associated with an increased risk for EBV infections in either of the groups. Treatment with two or more courses of ATG was found to be significantly associated with post-transplant EBV-related PTLD (P=0·01). Post-transplant EBV infections did not influence overall survival (non-malignant, P=0·66; malignant, P=0·41) in either of the subgroups. There were no deaths directly attributable to EBV infections.
Assuntos
Infecções por Vírus Epstein-Barr/etiologia , Doenças Hematológicas/cirurgia , Neoplasias Hematológicas/cirurgia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Adolescente , Adulto , Anticorpos Antivirais/sangue , Anticorpos Antivirais/imunologia , Soro Antilinfocitário/efeitos adversos , Soro Antilinfocitário/uso terapêutico , DNA Viral/genética , Ensaio de Imunoadsorção Enzimática , Infecções por Vírus Epstein-Barr/diagnóstico , Infecções por Vírus Epstein-Barr/virologia , Feminino , Transplante de Células-Tronco Hematopoéticas/métodos , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/imunologia , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Análise de Sobrevida , Transplante Homólogo , Adulto JovemRESUMO
The haematological indications for allogeneic stem cell transplantation can be broadly divided into non-malignant and malignant disorders. We compared the incidence and risk factors for post-transplant cytomegalovirus (CMV) infections between these two biologically diverse subgroups of haematological conditions. Out of 105 allogeneic transplants, 64 and 41 were for underlying non-malignant and malignant indications respectively. CMV infections were significantly more frequent (P=0.016) in the malignant subgroup. Pre-transplant recipient CMV seropositivity in both subgroups (negative versus positive; non-malignant,P=0.023; malignant, p<0.001), donor seropositivity (P=0.002) and acute graft-versus-host disease (GVHD) (P=0.02) in the non-malignant subgroup and > or =3 courses of previous cytotoxic therapy (P=0.023) in the malignant subgroup were found to be associated with an increased risk of CMV infections. On multivariate analysis, donor seropositivity in the non-malignant patients (negative versus positive,P=0.022; odds ratio: 0.18) and recipient seropositivity in patients with malignancies (negative versus positive; P=0.001, odds ratio: 0.01) were identified to be significant factors for risk of CMV infection.
Assuntos
Infecções por Citomegalovirus/epidemiologia , Doenças Hematológicas/cirurgia , Neoplasias Hematológicas/cirurgia , Transplante de Células-Tronco Hematopoéticas , Infecções Oportunistas/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Transplante de Medula Óssea/efeitos adversos , Transplante de Células-Tronco de Sangue do Cordão Umbilical , Infecções por Citomegalovirus/transmissão , Suscetibilidade a Doenças , Feminino , Doença Enxerto-Hospedeiro/tratamento farmacológico , Doença Enxerto-Hospedeiro/epidemiologia , Doenças Hematológicas/complicações , Neoplasias Hematológicas/complicações , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Incidência , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Transplante de Células-Tronco de Sangue Periférico/efeitos adversos , Estudos Prospectivos , Reoperação , Fatores de Risco , Transplante Homólogo/efeitos adversos , Ativação Viral , Adulto JovemRESUMO
The aim of the study was to determine if serial maternal urine polymerase chain reaction (PCR) tests can detect primary CMV infection during pregnancy. This was a prospective study conducted from 1 January 1999 to 31 December 1999 in an antenatal clinic setting of a teaching hospital. The study group included women who were CMV IgG negative and aged <30 years or had a pre-school child. They were invited to self-collect urine samples monthly and send them to the laboratory by post. Cord bloods were tested for CMV IgG to detect seroconversion. An anxiety questionnaire was sent to all study participants. At first attendance, 1549 (42%) women were CMV IgG negative. Of the 696 eligible women, 609 (88%) participated in the urine PCR study. PCR was performed on 2263 urine samples (median of 4/pregnancy). Primary CMV infection was identified in one woman by urine PCR at 36 weeks (baby CMV negative). Cord blood samples were available from 152/609 infants (25%). Seroconversion was noted in only one woman. Replies to the questionnaire were received from 264/609 women (43%): 214 (81%) had little or no anxiety, and 220 (83%) felt reassured by their study participation. Serial urine PCR is a feasible method of detecting primary maternal CMV infection during pregnancy which has potential for evaluation in further studies.