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Regimen-Related Mucosal Injury of the Gut Increased the Incidence of CMV Disease after Allogeneic Bone Marrow Transplantation

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Title: Regimen-Related Mucosal Injury of the Gut Increased the Incidence of CMV Disease after Allogeneic Bone Marrow Transplantation
Authors: Shigematsu, Akio Browse this author
Yasumoto, Atsushi Browse this author
Yamamoto, Satoshi Browse this author
Sugita, Junichi Browse this author
Kondo, Takeshi Browse this author →KAKEN DB
Onozawa, Masahiro Browse this author
Kahata, Kaoru Browse this author
Endo, Tomoyuki Browse this author
Ota, Shuichi Browse this author
Sato, Norihiro Browse this author
Takahata, Mutsumi Browse this author
Okada, Kohei Browse this author
Tanaka, Junji Browse this author →KAKEN DB
Hashino, Satoshi Browse this author
Nishio, Mitsufumi Browse this author
Koike, Takao Browse this author
Asaka, Masahiro Browse this author
Imamura, Masahiro Browse this author
Keywords: Reduced-intensity conditioning
Bone marrow transplantation
Cytomegalovirus infection
Mucosal injury
Graft-versus-host disease
Issue Date: Jun-2009
Publisher: Elsevier Inc.
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 15
Issue: 6
Start Page: 679
End Page: 685
Publisher DOI: 10.1016/j.bbmt.2009.02.006
PMID: 19450752
Abstract: Cytomegalovirus (CMV) infection is one of the major causes of morbidity in patients undergoing allogeneic stem cell transplantation (alloSCT). The incidences of CMV antigenemia and CMV disease in 43 patients who received allogeneic bone marrow transplantation (BMT) using a reduced-intensity conditioning (RIC) regimen, which mainly consisted of fluclarabine, busulfan and total body irradiation, were compared with those in 68 patients who received a myeloablative conditioning (MAC) regimen, and risk factors for CMV antigenemia and CMV disease were identified. Before engraftment, grade 3-4 mucosal injury due to the conditioning regimen was significantly decreased in RIC patients (stomatitis: P = 0.02; diarrhea: P < 0.01). Rate of engraftment, incidences of acute graft-versus-host disease (aGVHD) and rate of corticosteroid administration were not different in RIC patients and MAC patients. Although the incidences of CMV antigenemia were not significantly different in RIC patients and MAC patients (64.1% vs. 57.8%, logrank, P = 0.59), the incidence of CMV disease was significantly decreased in RIC patients (5.4% vs. 20.3%, logrank, P = 0.04). CMV seropositivity in the patients (P < 0.01) and corticosteroid administration (P < 0.01) were revealed by multivariate analysis to be significant risk factors for CMV antigenemia. Grade II-IV aGVHD (P = 0.02) and grade 3-4 diarrhea before engraftment (P = 0.04) were revealed to be risk factors for CMV disease. The present study is the first study to show that severe diarrhea before engraftment is a significant risk factor for CMV disease. In summary, risk of CMV disease was significantly decreased in patients without severe mucosal injury of the gut due to the conditioning regimen before engraftment.
Type: article (author version)
URI: http://hdl.handle.net/2115/38731
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 重松 明男

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