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Predictive factors of human cytomegalovirus reactivation in newly diagnosed glioblastoma patients treated with chemoradiotherapy
Journal of Neurovirology ( IF 2.3 ) Pub Date : 2021-01-06 , DOI: 10.1007/s13365-020-00922-4
R Ursu 1, 2 , J Doridam 3, 4 , E Chaugne 3 , H Zannou 3 , C Belin 1, 2 , S Cuzzubbo 1, 2 , L Sirven-Villaros 1, 2 , S Brichler 4, 5, 6 , C Levy-Piedbois 7 , A F Carpentier 1, 2
Affiliation  

The human cytomegalovirus (HCMV) is a ubiquitous herpes virus which infects 40 to 99% of the population. HCMV reactivation may occur in the context of immunosuppression and can induce significant morbidities. Several cases of HCMV infections or HCMV reactivation have thus been reported in glioblastoma (GBM) patients treated with radio(chemo)therapy. With the aim to identify the main risk factors associated with HCMV reactivation, we reviewed all patients treated for a newly diagnosed GBM in our institution from October 2013 to December 2015. Age, sex, Karnofsky performance status (KPS), absolute lymphocyte count (ALC), serological HCMV status, and steroid doses were recorded at the start and 1 month after the end of radiotherapy (RT). Within the 103 patients analyzed, 34 patients (33%) had an initial negative serology for HCMV, and none of them developed a seroconversion after treatment. Among patients with positive HCMV IgG (n = 69), 16 patients (23%) developed a viremia at one point during treatment. Age (> 60 years), steroid intake, and ALC (< 1500/mm3) before RT were correlated with HCMV reactivation. HCMV viremia was associated with neurological decline 1 month after chemoradiotherapy but progression-free survival was not impacted. A shorter overall survival was seen in these patients when compared with the others, but this could be biased by the older age in this subgroup. HCMV reactivation needs to be sought in case of a neurological decline during RT especially in older patients treated with steroids and low lymphocytes counts.



中文翻译:

新诊断胶质母细胞瘤患者放化疗后人巨细胞病毒再激活的预测因素

人类巨细胞病毒 (HCMV) 是一种普遍存在的疱疹病毒,可感染 40% 至 99% 的人口。HCMV 再激活可能发生在免疫抑制的背景下,并可能导致显着的发病率。因此,在接受放射(化学)疗法治疗的胶质母细胞瘤 (GBM) 患者中报告了几例 HCMV 感染或 HCMV 再激活病例。为了确定与 HCMV 再激活相关的主要危险因素,我们回顾了 2013 年 10 月至 2015 年 12 月在我们机构接受新诊断 GBM 治疗的所有患者。年龄、性别、卡诺夫斯基体能状态 (KPS)、绝对淋巴细胞计数 (ALC) )、血清 HCMV 状态和类固醇剂量在放疗 (RT) 开始和结束后 1 个月记录。在分析的 103 名患者中,34 名患者 (33%) 的 HCMV 初始血清学呈阴性,他们都没有在治疗后出现血清转换。在 HCMV IgG 阳性的患者中(n  = 69),16 名患者 (23%) 在治疗期间曾出现病毒血症。放疗前的年龄(> 60 岁)、类固醇摄入量和 ALC(< 1500/mm 3)与 HCMV 再激活相关。HCMV 病毒血症与放化疗后 1 个月的神经功能下降有关,但无进展生存期并未受到影响。与其他患者相比,这些患者的总生存期较短,但这可能会受到该亚组年龄较大的影响。在放疗期间神经功能下降的情况下需要寻求 HCMV 再激活,尤其是在接受类固醇治疗和低淋巴细胞计数的老年患者中。

更新日期:2021-01-06
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