van Kraaij M G J, Verdonck L F, Rozenberg-Arska M, Dekker A W
Department of Haematology, University Medical Centre, Utrecht, The Netherlands.
Bone Marrow Transplant. 2002 Sep;30(5):303-9. doi: 10.1038/sj.bmt.1703643.
We compared the incidence of early infectious complications between matched related (MR) and matched unrelated/mismatched (MU/MM) allogeneic stem cell transplant (allo-SCT) recipients in a single centre over a 6-year period in 214 consecutive adult patients. Early infections were defined as occurring from hospital admission for SCT until discharge. One hundred and fifty-nine patients received an allograft from MR donors and 55 patients received MU/MM allo-SCT. One hundred and eight of 214 patients had 147 episodes of fever. Ninety-three episodes (63%) were due to clinically or microbiologically documented infections and 54 episodes (37%) to fever not related to infection. Patients undergoing MU/MM transplantation tended to have more documented infections compared to recipients of MR allo-SCT (P = 0.06). Significantly more MU/MM transplant recipients had breakthrough infections with Herpes simplex virus type 1 (HSV-1, P = 0.003), and more CMV reactivation (P = 0.015). The mortality rate in all patients during hospitalisation post-SCT was 6.3% in MR and 18.2% in MU/MM allo-SCT recipients (P = 0.009). Early mortality was associated with infection in 70% of the patients, with a similar distribution between MR and MU/MM transplant recipients. However, MU/MM transplant recipients had significantly more early deaths due to toxic causes (P < 0.001). We conclude that early post-transplant MU/MM transplant recipients tend to have more documented infections, and have significantly more breakthrough infections with HSV-1 and more CMV reactivation. MU/MM transplant recipients are at higher risk of early mortality, especially due to toxic causes.
我们比较了在6年期间，单中心214例连续成年患者中，匹配的亲属供者（MR）与匹配的非亲属/不匹配供者（MU/MM）的异基因干细胞移植（allo-SCT）受者早期感染并发症的发生率。早期感染定义为从SCT住院至出院期间发生的感染。159例患者接受了MR供者的同种异体移植物，55例患者接受了MU/MM allo-SCT。214例患者中有108例出现147次发热。93次发热（63%）是由于临床或微生物学证实的感染，54次发热（37%）与感染无关。与MR allo-SCT受者相比，接受MU/MM移植的患者往往有更多的证实感染（P = 0.06）。MU/MM移植受者发生单纯疱疹病毒1型（HSV-1）突破性感染的比例显著更高（P = 0.003），巨细胞病毒再激活的比例也更高（P = 0.015）。SCT后住院期间，所有患者的死亡率在MR allo-SCT受者中为6.3%，在MU/MM allo-SCT受者中为18.2%（P = 0.009）。70%的患者早期死亡与感染有关，MR和MU/MM移植受者之间的分布相似。然而，MU/MM移植受者因毒性原因导致的早期死亡显著更多（P < 0.001）。我们得出结论，移植后早期，MU/MM移植受者往往有更多的证实感染，HSV-1突破性感染和巨细胞病毒再激活显著更多。MU/MM移植受者早期死亡风险更高，尤其是因毒性原因。
