异基因造血干细胞移植后巨细胞病毒肺炎34例临床研究

OBJECTIVE: To analyze the clinical features and prognosis of cytomegalovirus pneumonia after allogeneic hematopoietic stem cell transplantation（allo-HSCT）. METHODS: We reviewed the clinical features and laboratory data of cytomegalovirus pneumonia patients after allogeneic peripheral blood HSCT from March 1, 2016 to June 30, 2019 at the hematology department of the Shanghai general hospital and analyze the prognostic factors. RESULTS: Of the 411 allo-HSCT patients, 34（8.3％）developed CMV pneumonia after transplantation, including 18 men and 16 women, with a median age of 32（8–62）y. Total 14 patients had acute myeloid leukemia, 10 had acute lymphoblastic leukemia, 5 had myelodysplastic syndrome, 3 had non-Hodgkin's lymphoma, and 2 had aplastic anemia. The median onset time for CMV pneumonia was 53（36−506）d after transplantation. The main symptoms were cough（26 cases, 76.5％）, fever（23 cases, 67.6％）, and shortness of breath（14 cases, 41.2％）. Only 17.6％（6/34）patients had expectoration, and 2 cases（5.9％）had no obvious symptoms in the early stage, but were diagnosed on routine chest CT examination. Twenty-eight （82.4％） patients showed signs of typical interstitial pneumonia, such as lobular central nodule and diffuse ground glass opacity; 6（17.6％）patients showed atypical imaging changes of patch, nodule, and consolidation. Further, 26 patients（76.5％）were positive for CMV-DNA, and the copy number was lower than that of BALF［1.70×10(7)（5.44×10(5)–4.45×10(9)）copies/L vs 1.45×10(8)（1.10×10(7)–1.10×10(11)）copies/L, P＝0.004］. Thirteen（38.24％）patients with CMV pneumonia had mixed infection with other lower respiratory tract pathogens（10 strains of fungi, 6 strains of bacteria, and 1 of adenoviruses）. The median follow-up duration was 12.8（0.4–46.5）months. The OS rate was 58.82％. Age ≥ 40 y and high flow ventilation were independent risk factors for poor prognosis in CMV pneumonia patients （P＝0.049, P＝0.009）. CONCLUSION: Bronchoscopic bronchoalveolar lavage fluid detection helps in improving the accuracy of the etiological diagnosis of CMV pneumonia after allo-HSCT. Age ≥ 40 y and high flow ventilation were independent risk factors for poor prognosis in patients with CMV pneumonia.