Hematopoetik kök hücre transplant alıcılarında cytomegalovirus, Epstein-Barr virus ve adenovirus enfeksiyonlarının izlenmesi

Year 2023, Volume: 48 Issue: 2, 432 - 440, 02.07.2023

Buket Şeflek , Hale Gümüş , Mehmet Çimentepe , Serhan Küpeli , Fügen Yarkın

https://doi.org/10.17826/cumj.1239938

Cited By: 1

Abstract

Amaç: İyatrojenik immünsüpresyonu olan hematopoetik kök hücre transplant (HKHT) alıcıları viral enfeksiyonlar için yüksek riskli hastalardır. Bu çalışmanın amacı, HKHT alıcılarında cytomegalovirus (CMV), Epstein-Barr virus (EBV) ve adenovirus (ADV) enfeksiyonlarının insidansını araştırmaktır.
Gereç ve Yöntem: Yaşları 0-17 arasında allojenik (n=30) ve otolog (n=5) HKHT'si olan 35 hasta prospektif olarak CMV, EBV ve ADV için kantitatif gerçek zamanlı polimeraz zincir reaksiyonu testleri ile izlendi. Monitorizasyon, HKHT'den bir hafta önce başladı ve HKHT'den sonra ilk 100 gün için haftalık, bir yıla kadar ayda bir yapıldı. Ek olarak, virüsler için seropozitiflik, transplantasyondan bir hafta önce Enzyme-Linked Immunosorbent Assay ile analiz edildi.
Bulgular: Transplantasyon öncesi HKHT yapılan 35 (%100) hastanın tamamı CMV IgG pozitif, 30 (%85.7- 95% CI: 74.1%-97.3%) HKHT alıcısı EBV IgG pozitif bulundu. Allojenik HKHT hastalarının 24'ünde (%80 - 95% CI: 65.7%-94.3%) CMV enfeksiyonu, 11'inde (%36.7 - 95% CI: 19.4%-53.9%) ADV enfeksiyonu ve 8'inde (%26.7) EBV enfeksiyonu bulundu. Bu grupta biri (%3.3) EBV DNA ve biri (%3.3) ADV DNA ile koenfekte olan 8 hastada (%26.7) CMV DNA viral yükü preemptif tedavi için gerekli olan 1000 kopya/mL üzerindeydi. Otolog 5 HKHT alıcısından CMV DNA 2 hastada, EBV DNA 5 hastada ve ADV DNA 2 hastada tespit edildi. Preemptif tedavi 35 hastanın 11'ine (%31.4 - 95% CI: 16%-46.8%; 6 CMV, 2 EBV, 1 ADV, 1 CMV-EBV ve 1 CMV-ADV enfeksiyonu) verildi. Böylece 7 (%63.6 - 95% CI: 35.2%-92.1%) hastada viral hastalık gelişimi engellendi. Toplam 35 hastadan sadece 2'si (%5.7 - 95% CI: 0.0%-13.4%)) viral enfeksiyon nedeniyle kaybedildi.
Sonuç: HKHT hastalarında viral yüklerin prospektif olarak izlenmesi ile viral enfeksiyonların erken tanısı, preemptif tedavinin zamanında başlatılmasını sağlayarak morbidite ve mortaliteyi önlemede etkili olacaktır.

Keywords

CMV, EBV, ADV, hematopoetik kök hücre transplantasyonu

Supporting Institution

Çukurova Üniversitesi

Project Number

TF2013D4

Monitoring of cytomegalovirus, Epstein-Barr virus and adenovirus infections in hematopoietic stem cell transplant recipients

Abstract

Purpose: Haematopoietic stem cell transplant (HSCT) recipients with iatrogenic immunosuppression are high-risk patients for viral infections. The aim of this study was to investigate the incidence of cytomegalovirus (CMV), Epstein-Barr virus (EBV), and adenovirus (ADV) infections in HSCT recipients.
Materials and Methods: We prospectively monitored 35 patients aged 0-17 years who had allogeneic (n=30) and autologous (n=5) HSCT by quantitative real-time polymerase chain reaction tests for CMV, EBV, and ADV. The monitoring was performed one week before HSCT and weekly for the first 100 days, once a month up to one year after HSCT. In addition, seropositivity for viruses was analysed by Enzyme-Linked Immuno Sorbent Assay a week before transplantation.
Results: Before transplantation, all 35 (100%) patients who underwent HSCT were CMV IgG positive, 30 (85.7% - 95% CI: 74.1%-97.3%) HSCT recipients were found to be EBV IgG positive. CMV infection was found in 24 (80% - 95% CI: 65.7%-94.3%), ADV infection in 11 (36.7% - 95% CI: 19.4%-53.9%) and EBV infection in 8 (26.7% - 95% CI: 10.8%-42.5%) allogeneic HSCT patients. In this group, CMV DNA viral load in 8 (26.7%) patients, of which one (3.3%) coinfected with EBV DNA and one (3.3%) with ADV DNA, was higher than 1000 copies/mL which was required for pre-emptive treatment. Among 5 autologous HSCT recipients, CMV DNA was detected in 2 patients, EBV DNA in 5 and ADV DNA in 2. Pre-emptive treatment was given to 11 (%31.4 - 95% CI: 16%-46.8%; 6 CMV, 2 EBV, 1 ADV, 1 CMV-EBV and 1 CMV-ADV infection) of 35 patients. Thus, the development of viral disease was prevented in 7 (63.6% - 95% CI: 35.2%-92.1%). Of the total 35 patients, only 2 (5.7% - 95% CI: 0.0%-13.4%) died due to viral infection.
Conclusion: Early diagnosis of viral infections by prospective monitoring of viral loads in HSCT patients would be effective in preventing morbidity and mortality by ensuring timely initiation of pre-emptive therapy.

Keywords

CMV, EBV, ADV, hematopoietic stem cell transplantation

Project Number

TF2013D4

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