Conclusioni

In conclusione possiamo affermare che, grazie al ricorso alla terapia pre-emptive, ad oggi siamo capaci di gestire la riattivazione del CMV al punto che quest’ultima non ha un impatto significativo sull’outcome dei pazienti pediatrici sottoposti a TCSE. La terapia pre-emptive si è dimostrata ben tollerata dai pazienti, divenendo un elemento terapeutico fondamentale nella gestione del paziente sottoposto a TCSE.

Il CMV, comunque, resta un elemento fonte di preoccupazione nel contesto del TCSE, in quanto l’eventuale CMVD conseguente alla riattivazione può essere responsabile dell’exitus del paziente: questo giustifica ulteriormente la necessità di ricorrere alla terapia pre-emptive, che consente di intervenire ben prima che si sviluppi la CMVD.

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Infine, la relazione temporale che sussiste tra la riattivazione del CMV e l’insorgenza della aGVHD non è diretta: non è la aGVHD stessa a incrementare il rischio di riattivazione del CMV; piuttosto, tale relazione risulta essere spiegata principalmente dalla terapia steroidea. Questa viene somministrata ai pazienti per gestire la aGVHD, ma induce quello stato di immunosoppressione che giustifica la successiva riattivazione del CMV: siamo dunque capaci di trattare la aGVHD, ma rendiamo la terapia stessa un fattore di rischio di riattivazione. A questo fenomeno partecipano però anche altri fattori di rischio, che nel nostro studio sono risultati essere il tipo di TCSE e lo status sierologico pre-TCSE, i quali rendono ben più complessa la definizione del rischio di riattivazione del CMV. Non possiamo dunque stabilire una corrispondenza biunivoca tra la riattivazione del CMV e uno specifico fattore, essendo presenti più variabili, ciascuna responsabile di una percentuale del rischio globale di riattivazione.

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