Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
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Effect of Conditioning Regimen Intensity on Cytomegalovirus Infection and Related Risk Factors Analysis in Allogeneic Hematopoietic Stem Cell Transplantation

동종조혈모세포이식에서 거대세포바이러스 감염에 미치는 전처치요법 강도의 영향과 관련위험인자 분석

  • Lee, Hye-Min (Department of Pharmacy, Samsung Medical Center) ;
  • Heo, Yoon-Jeong (Department of Pharmacy, Samsung Medical Center) ;
  • Im, Hyun-Jeong (Department of Pharmacy, Samsung Medical Center) ;
  • Chung, Seon-Young (Department of Pharmacy, Samsung Medical Center) ;
  • In, Yong-Won (Department of Pharmacy, Samsung Medical Center) ;
  • Jung, Chul-Won (Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Young-Mee (Department of Pharmacy, Samsung Medical Center) ;
  • Sohn, Kie-Ho (College of Pharmacy, Kyungsung University)
  • 이혜민 (삼성서울병원 약제부) ;
  • 허윤정 (삼성서울병원 약제부) ;
  • 임현정 (삼성서울병원 약제부) ;
  • 정선영 (삼성서울병원 약제부) ;
  • 인용원 (삼성서울병원 약제부) ;
  • 정철원 (성균관대학교 의과대학 삼성서울병원 내과학교실 혈액종양내과) ;
  • 이영미 (삼성서울병원 약제부) ;
  • 손기호 (경성대학교 약학대학)
  • Received : 2012.03.23
  • Accepted : 2012.05.30
  • Published : 2012.06.30
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Abstract

거대세포바이러스(Cytomegalovirus; CMV) 감염은 동종조혈모세포이식 환자의 주요 사망원인 중 하나이다. 용량감소전처치(Reduced-intensity conditioning; RIC)를 이용한 조혈모세포이식은 골수억제전처치(Myeloablative conditioning; MAC)에 비해 골수억제 및 면역억제가 적으므로 CMV 감염 발생율을 감소시킬 것이라 예상되었으나 예방적 면역억제요법, T세포 제거 약제의 사용 등으로 서로 상이한 결과가 보고되고 있다. 2007년 1월부터 2009년 12월까지 총 141명의 환자(MAC 113명, RIC 28명)가 동종조혈모세포이식을 받았으며, CMV 감염은 MAC 62.8%, RIC 57.1% (p = 0.310), CMV 질환은 각각 12.4%, 14.3% (p = 0.785)에서 발생하였다. CMV 감염/질환 발생빈도와 CMV 항원 혈증검사 지속기간, 초기/최고치, 생존율은 두 군간 유의한 차이가 없었다. CMV 감염 위험인자에 대한 다변량분석 결과, 환자가 고령일수록(HR 1.024, 95% CI 1.002-1.045; p = 0.031) 또는 grade 2 이상의 급성 이식편대숙주병이 발생한 경우에(HR 1.849, 95% CI 1.031-3.315; p=0.039) CMV 감염 발생 위험율이 유의하게 높았다. 결론적으로, 전처치요법 강도에 따른 CMV 감염의 발생빈도와 발현양상의 차이는 없었으나, 고령이거나 grade 2 이상의 급성 이식편대숙주병이 발생한 환자의 경우 CMV 감염 발생과 유의한 연관성을 보였다. 이상과 같은 결과에 비춰 봐서 CMV 질환이 대부분 이식 100일 이후에 발생한 점을 고려할 때, 이식 후 CMV 감염 발생 시 ganciclovir 선제요법과 함께 이들 환자들에게 지속적인 모니터링을 실시하는 것이 필요할 것으로 사료된다.

Keywords

References

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