Korean J Hematol 1997; 32(3):
Published online September 30, 1997
© The Korean Society of Hematology
조혈모세포이식 환자에서 거대세포바이러스 감염 양상
김성철, 한지숙, 정소영, 이석, 유내춘, 민유홍, 고윤웅
연세대학교 의과대학 내과학교실
Cytomegalovirus Infection in Stem Cell Transplantation
Background: Cytomegalovirus(CMV) infection causes the greatest morbidity and mortality after stem cell transplantation(SCT), and in many western studies, CMV
infection develops in approximately 70 to 80% of patients treated with allogeneic bone marrow transplantation(BMT). There have been no reports regarding the prevalence and
clinical features of CMV infection and disease in patients receiving SCT in Korea. Therefore, we investigated the frequency and clinical characteristics of CMV infection in
53 cases of SCT.
Methods: Underlying diseases were acute myelocytic leukemia(n=21), acute lymphocytic leukemia(n=14), chronic myelocytic leukemia(n=4), severe aplastic anemia(n=13) and non Hodgkin lymphoma(n=1). Pre-transplant serostatus of donors and recipients was all positive for CMV infection. For screening test of CMV detection, CMV antigen assay or shell vial culture was done. CMV infection was defined as CMV antigenemia or recovery of CMV in culture or positive CMV PCR, and CMV disease was diagnosed when patients had symptoms and signs of specific organs with CMV infection.
Results:
1) The incidence of CMV infection was 18.9%(10/53) in all transplant recipients. No significant difference of rate of infection and disease between allogeneic BMT and
autologous peripheral blood stem cell transplantation was observed.
2) Five of 10 patients with CMV infection had asymptomatic CMV infection, and the other 5 patients developed overt CMV disease.
3) There was no difference of incidence of CMV infection according to age, type of SCT and use of total body irradiation. But, patients with acute graft-versus-host
disease(GVHD) had significantly higher incidence of CMV infection than those without acute GVHD in allogeneic BMT(33.3 vs. 7.4%; P=0.04).
4) CMV antigen assay was evaluated as the most sensitive method for the detection of CMV(83.3%), whereas CMV culture showed the lowest sensitivity(37.5%).
Conclusions : The lower incidence of CMV infection of patients with SCT in our study than that of other westers countries may be associated with low incidence of acute GVHD.
Keywords Cytomegalovirus; Stem cell transplantation; Acute GVHD;
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Korean J Hematol 1997; 32(3): 388-397
Published online September 30, 1997
Copyright © The Korean Society of Hematology.
조혈모세포이식 환자에서 거대세포바이러스 감염 양상
김성철, 한지숙, 정소영, 이석, 유내춘, 민유홍, 고윤웅
연세대학교 의과대학 내과학교실
Cytomegalovirus Infection in Stem Cell Transplantation
Seong Cheol Kim, Jee Sook Hahn, So Young Chong, Seok Lee, Nae Choon Yoo, Yoo Hong Min, Yun Woong Ko
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Abstract
Background: Cytomegalovirus(CMV) infection causes the greatest morbidity and mortality after stem cell transplantation(SCT), and in many western studies, CMV
infection develops in approximately 70 to 80% of patients treated with allogeneic bone marrow transplantation(BMT). There have been no reports regarding the prevalence and
clinical features of CMV infection and disease in patients receiving SCT in Korea. Therefore, we investigated the frequency and clinical characteristics of CMV infection in
53 cases of SCT.
Methods: Underlying diseases were acute myelocytic leukemia(n=21), acute lymphocytic leukemia(n=14), chronic myelocytic leukemia(n=4), severe aplastic anemia(n=13) and non Hodgkin lymphoma(n=1). Pre-transplant serostatus of donors and recipients was all positive for CMV infection. For screening test of CMV detection, CMV antigen assay or shell vial culture was done. CMV infection was defined as CMV antigenemia or recovery of CMV in culture or positive CMV PCR, and CMV disease was diagnosed when patients had symptoms and signs of specific organs with CMV infection.
Results:
1) The incidence of CMV infection was 18.9%(10/53) in all transplant recipients. No significant difference of rate of infection and disease between allogeneic BMT and
autologous peripheral blood stem cell transplantation was observed.
2) Five of 10 patients with CMV infection had asymptomatic CMV infection, and the other 5 patients developed overt CMV disease.
3) There was no difference of incidence of CMV infection according to age, type of SCT and use of total body irradiation. But, patients with acute graft-versus-host
disease(GVHD) had significantly higher incidence of CMV infection than those without acute GVHD in allogeneic BMT(33.3 vs. 7.4%; P=0.04).
4) CMV antigen assay was evaluated as the most sensitive method for the detection of CMV(83.3%), whereas CMV culture showed the lowest sensitivity(37.5%).
Conclusions : The lower incidence of CMV infection of patients with SCT in our study than that of other westers countries may be associated with low incidence of acute GVHD.
Keywords: Cytomegalovirus, Stem cell transplantation, Acute GVHD,
