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血液病患者和造血干细胞移植后巨细胞病毒感染管理指南,源自 2017 年白血病感染的欧洲会议(ECIL 7)。

Guidelines for the management of cytomegalovirus infection in patients with haematological malignancies and after stem cell transplantation from the 2017 European Conference on Infections in Leukaemia (ECIL 7).

机构信息

Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital, and Division of Hematology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.

Department of Hematology, Hospital de la Princesa, Madrid, Spain.

出版信息

Lancet Infect Dis. 2019 Aug;19(8):e260-e272. doi: 10.1016/S1473-3099(19)30107-0. Epub 2019 May 29.

Abstract

Cytomegalovirus is one of the most important infections to occur after allogeneic haematopoietic stem cell transplantation (HSCT), and an increasing number of reports indicate that cytomegalovirus is also a potentially important pathogen in patients treated with recently introduced drugs for hematological malignancies. Expert recommendations have been produced by the 2017 European Conference on Infections in Leukaemia (ECIL 7) after a review of the literature on the diagnosis and management of cytomegalovirus in patients after HSCT and in patients receiving other types of therapy for haematological malignancies. These recommendations cover diagnosis, preventive strategies such as prophylaxis and pre-emptive therapy, and management of cytomegalovirus disease. Antiviral drugs including maribavir and letermovir are in development and prospective clinical trials have recently been completed. However, management of patients with resistant or refractory cytomegalovirus infection or cytomegalovirus disease is a challenge. In this Review we summarise the reviewed literature and the recommendations of the ECIL 7 for management of cytomegalovirus in patients with haematological malignancies.

摘要

巨细胞病毒是异基因造血干细胞移植(HSCT)后发生的最重要感染之一,越来越多的报告表明,巨细胞病毒也是接受最近用于血液系统恶性肿瘤的药物治疗的患者的一个潜在重要病原体。在对 HSCT 后患者和接受其他类型血液系统恶性肿瘤治疗的患者的巨细胞病毒诊断和管理文献进行审查后,2017 年欧洲白血病感染会议(ECIL 7)制定了专家建议。这些建议涵盖了巨细胞病毒疾病的诊断、预防策略(如预防和先发治疗)以及管理。包括马拉韦罗和来特莫韦在内的抗病毒药物正在开发中,最近已经完成了前瞻性临床试验。然而,治疗耐药或难治性巨细胞病毒感染或巨细胞病毒疾病的患者是一个挑战。在这篇综述中,我们总结了审查的文献和 ECIL 7 对血液系统恶性肿瘤患者巨细胞病毒管理的建议。

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