CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
英文原题：Cytomegalovirus DNAemia and disease: current-era epidemiology, clinical characteristics and outcomes in cancer patients other than allogeneic haemopoietic transplantation.
Cytomegalovirus DNAemia and disease: current-era epidemiology, clinical characteristics and outcomes in cancer patients other than allogeneic haemopoietic transplantation.
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血液系统恶性肿瘤患者，尤其是 B 细胞 LPD、T 细胞 LPD、慢性淋巴细胞白血病和多发性骨髓瘤患者，常被发现存在 CMV DNA 血症和 CMV 病。淋巴细胞减少、多种癌症治疗、合并感染以及近期接受全身性糖皮质激素治疗也较为常见。未来需要开展研究以确定这些患者中 CMV 的最佳识别和管理策略。
高强度化疗和新型免疫疗法的进展使得除异基因造血细胞移植（HCT）外的癌症患者中出现巨细胞病毒（CMV）感染。目的 评估该人群中CMV感染的流行病学、临床特征和结局。
对2013年7月至2020年5月期间在一家四级癌症中心发生CMV DNA血症和/或疾病、且未接受异基因HCT的癌症患者进行了回顾性审查。
在这一期间接受治疗的11 485例癌症患者中，953例患者进行了CMV DNA检测，其中238例存在CMV DNA血症。排除接受异基因HCT的患者后，共识别出62例CMV DNA血症患者，其中10例合并CMV病。最常见的 underlying malignancies 为B细胞淋巴增殖性疾病（LPD）（31%；19/62）、T细胞LPD（21%；13/62）、慢性淋巴细胞白血病（11%；7/62）和多发性骨髓瘤（10%；6/62）。大多数患者在CMV诊断前1个月内存在淋巴细胞减少（77%；48/62）、接受多种癌症治疗（63%；39/62既往接受过≥2种治疗）、合并感染（56%；35/62有≥1种合并感染）以及接受皮质类固醇治疗（48%；30/62）。在接受新型免疫治疗的患者中观察到CMV DNA血症和CMV病，包括双特异性抗体治疗、CAR-T 细胞治疗和免疫检查点抑制剂。
High-intensity chemotherapy and advances in novel immunotherapies have seen the emergence of cytomegalovirus (CMV) infections in cancer patients other than allogeneic haemopoietic cell transplantation (HCT). Aim To evaluate the epidemiology, clinical characteristics and outcomes of CMV infection in this population.
A retrospective review of cancer patients other than allogeneic HCT who had CMV DNAemia and/or disease from July 2013 till May 2020 at a quaternary cancer centre was performed.
Of 11 485 cancer patients who underwent treatment during this period, 953 patients had CMV DNA testing performed and 238 of them had CMV DNAemia. After excluding patients with allogeneic HCT, 62 patients with CMV DNAemia were identified, of whom 10 had concurrent CMV disease. The most frequent underlying malignancies were B-cell lymphoproliferative disease (LPD) (31%; 19/62), T-cell LPD (21%; 13/62), chronic lymphocytic leukaemia (11%; 7/62) and multiple myeloma (10%; 6/62). Most patients had lymphopenia (77%; 48/62), multiple cancer therapies (63%; 39/62 received ≥2 previous therapies), co-infection (56%; 35/62 had ≥1 co-infection) and corticosteroid therapy (48%; 30/62) within 1 month before CMV diagnosis. CMV DNAemia and disease were observed in patients receiving novel immunotherapies, including bispecific antibody therapy, chimeric-antigen receptor T-cell therapy and immune checkpoint inhibitors.
Patients with haematological malignancy, particularly B-cell LPD, T-cell LPD, chronic lymphocytic leukaemia and multiple myeloma, were frequently identified to have CMV DNAemia and disease. Lymphopenia, multiple cancer therapies, co-infection and recent receipt of systemic corticosteroids were also commonly observed. Future studies are necessary to determine optimal identification and management of CMV in these patients.
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