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Цитомегаловирусная инфекция при трансплантации аллогенных гемопоэтических стволовых клеток: основное клиническое значение и определения

https://doi.org/10.23873/2074-0506-2022-14-2-210-225

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Аннотация

Цитомегаловирусная инфекция является лидирующей причиной смертности у пациентов после трансплантации аллогенных гемопоэтических стволовых клеток, особенно в ранние сроки.

Одними из наиболее значимых факторов риска развития цитомегаловирусной инфекции у реципиентов аллогенных гемопоэтических стволовых клеток являются цитомегаловирусная серопозитивность донора и (или) реципиента, а также недостаточная и (или) отсроченная реконституция цитомегаловирусных специфических CD4+ и CD8+ Т-лимфоцитов после трансплантации аллогенных гемопоэтических стволовых клеток.

Спектр клинических проявлений разнообразен: как от бессимптомного течения, так и до развития цитомегаловирусной болезни с вовлечением органов-мишеней, что случается в 10–40% случаев. На сегодняшний день доступны публикации, подтверждающие как неблагоприятное, так и «положительное» влияние цитомегаловируса на отдаленные результаты у пациентов после трансплантации аллогенных гемопоэтических стволовых клеток. Острая и хроническая реакция «трансплантат против хозяина» могут также являться факторами риска развития цитомегаловирусной инфекции. В некоторых работах описано влияние цитомегаловирусной инфекции на развитие несостоятельности трансплантата. Однако известен и «противолейкемический эффект» цитомегаловирусной инфекции, когда эпизод цитомегаловирусной инфекции снижает вероятность развития рецидива у пациентов с острым миелоидным лейкозом, хроническим миелолейкозом.

Несмотря на внедрение стратегий профилактической, превентивной и таргетной терапии цитомегаловирусной инфекции, она до сих пор ухудшает посттрансплантационные показатели.

Целью этого обзора стала систематизация современных понятий, применяемых при оценке и лечении цитомегаловирусной инфекции у пациентов после трансплантации аллогенных гемопоэтических стволовых клеток.

Об авторах

А. А. Дмитрова
ФГБУ «НМИЦ гематологии» МЗ РФ
Россия

Анна Александровна Дмитрова, врач-гематолог, отделение интенсивной высокодозной химиотерапии и трансплантации костного мозга с круглосуточным стационаром

125167, Москва, Новый Зыковский пр-д, д. 4



М. Ю. Дроков
ФГБУ «НМИЦ гематологии» МЗ РФ
Россия

Михаил Юрьевич Дроков, канд. мед. наук, врач-гематолог, руководитель сектора по изучению иммунных воздействий и осложнений после трансплантации костного мозга

125167, Москва, Новый Зыковский пр-д, д. 4



Т. А. Туполева
ФГБУ «НМИЦ гематологии» МЗ РФ
Россия

Татьяна Алексеевна Туполева, д-р мед. наук, врач-вирусолог, заведующий отделом вирусологической диагностики

125167, Москва, Новый Зыковский пр-д, д. 4



В. Г. Савченко
ФГБУ «НМИЦ гематологии» МЗ РФ
Россия

Валерий Григорьевич Савченко, академик РАН, проф., д-р мед. наук, генеральный директор

125167, Москва, Новый Зыковский пр-д, д. 4



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Рецензия

Для цитирования:


Дмитрова А.А., Дроков М.Ю., Туполева Т.А., Савченко В.Г. Цитомегаловирусная инфекция при трансплантации аллогенных гемопоэтических стволовых клеток: основное клиническое значение и определения. Трансплантология. 2022;14(2):210-225. https://doi.org/10.23873/2074-0506-2022-14-2-210-225

For citation:


Dmitrova A.A., Drokov M.Yu., Tupoleva T.A., Savchenko V.G. Cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation: clinical significance and definitions. Transplantologiya. The Russian Journal of Transplantation. 2022;14(2):210-225. https://doi.org/10.23873/2074-0506-2022-14-2-210-225

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