T细胞去除的造血干细胞移植后的感染性并发症。

Novitzky N, Rouskova A

The University of Cape Town Leukaemia Centre, Department of Haematology, Groote Schuur Hospital, Cape Town, South Africa.

Cytotherapy. 2001;3(3):165-73. doi: 10.1080/146532401753173990.

BACKGROUND

Although sepsis is a common complication during stem-cell transplantation, the prevalence of infections after hematopoietic recovery is less well known.

METHODS

We undertook a retrospective analysis of infectious episodes in patients who underwent allogeneic BM (n = 77) or PBSC (n = 29) grafting from HLA identical siblings. T-cell depletion of the stem-cell grafts with anti CD 52 (CAMPATH-1) Abs was employed for the prevention of GvHD.

RESULTS

Patients' median age was 30 (4-54) years. Antibiotic prophylaxis was with oral amphotericin, ofloxacin and i.v. or oral acyclovir. Fever was treated empirically with a third generation cephalosporin and aminoglucosides until results of microbiological cultures became available. Six patients died of graft failure. GvHD was observed in 18% but in no case was it > Grade II. Only seven patients did not develop pyrexia during the initial admission or within 60 days following graft infusion. Median duration of pyrexia was 10 (range 2-49) days. A microbial source was detected in 42% and it was Gram (+) in 86%, Gram (-) in 11% and fungal in 3%. In 16 patients, indwelling venous catheters were removed due to severe infection. Subsequent to the recovery of the blood parameters, the most prevalent infection was by herpes varicella/zoster in 20; another 17 developed herpes simplex. In total 40/102 were re-hospitalized for pyrexia, which in four cases was of unknown origin. Bacterial infections with Staphylococcus Aureus and S. Epidermitis were seen in 10 and seven patients respectively. CMV was detected in seven patients. Thirteen patients died of sepsis and in 10, it was related to GvHD or graft failure. Another 20 died following recurrence of the malignancy. Overall, 39 patients died and 63% survived at a median DFS of 1992 (range 623-5092) days.

DISCUSSION

We conclude that during the initial neutropenic period the dominant infections are by Gram (+) organisms, often associated with indwelling catheters. Once the BM has recovered, the main morbidity is by viral infections, but Gram+ organisms still remain common bacterial pathogens.

背景

尽管脓毒症是干细胞移植期间常见的并发症，但造血恢复后感染的发生率却鲜为人知。

方法

我们对接受来自 HLA 相同同胞的异基因骨髓移植（n = 77）或外周血干细胞移植（n = 29）的患者的感染发作进行了回顾性分析。采用抗 CD52（CAMPATH-1）抗体对干细胞移植物进行 T 细胞清除以预防移植物抗宿主病（GvHD）。

结果

患者的中位年龄为 30（4 - 54）岁。抗生素预防用药为口服两性霉素、氧氟沙星以及静脉或口服阿昔洛韦。发热时经验性使用第三代头孢菌素和氨基糖苷类药物治疗，直至微生物培养结果出来。6 例患者死于移植失败。观察到 18%的患者发生了移植物抗宿主病，但无一例超过 II 级。仅 7 例患者在初次入院期间或移植输注后 60 天内未出现发热。发热的中位持续时间为 10（范围 2 - 49）天。42%的患者检测到微生物来源，其中 86%为革兰氏阳性菌，11%为革兰氏阴性菌，3%为真菌。16 例患者因严重感染拔除了留置静脉导管。血液参数恢复后，最常见的感染是 20 例水痘 - 带状疱疹病毒感染；另外 17 例发生单纯疱疹病毒感染。总共 40/102 例患者因发热再次住院，其中 4 例病因不明。金黄色葡萄球菌和表皮葡萄球菌引起的细菌感染分别见于 10 例和 7 例患者。7 例患者检测到巨细胞病毒（CMV）。13 例患者死于脓毒症，10 例与移植物抗宿主病或移植失败有关。另外 20 例患者在恶性肿瘤复发后死亡。总体而言，39 例患者死亡，63%的患者存活，中位无病生存期为 1992（范围 623 - 5092）天。