Nachbaur David, Larcher Clara, Kircher Brigitte, Eibl Günther, Nussbaumer Walter, Gunsilius Eberhard, Haun Margot, Grünewald Kurt, Gastl Günther
Division of Hematology & Oncology, BMT Unit, Department of Internal Medicine, Innsbruck University Hospital, Anichstrasse 35, 6020 Innsbruck, Austria.
Ann Hematol. 2003 Oct;82(10):621-7. doi: 10.1007/s00277-003-0706-1. Epub 2003 Aug 15.
Preliminary data suggest a faster immune recovery following non-myeloablative stem cell transplantation because of the persistence of recipient T cells, but the real impact on post-transplant infectious complications remains unknown. We retrospectively analysed the incidence of cytomegalovirus (CMV) infection in twenty patients following reduced intensity conditioning with busulfan/fludarabine+/-thiotepa and post-transplant immunosuppression with cyclosporine A/mycophenolate mofetil. Results were compared with 20 patients receiving myeloablative transplants during the same time period and who were matched for CMV risk group and for donor origin. The cumulative incidence of CMV infection following reduced intensity vs. myeloablative transplants was 60.4% vs. 40.0%, respectively (p value 0.1, log rank test). The risk for CMV infection in both cohorts was increased after in vivo T cell depletion with antithymocyte globulin (75% and 60%, respectively). Acute GVHD preceded the diagnosis of CMV infection by a median of 25 (range, 9-61) days following reduced intensity transplants and a median of 14 (range, 10-34) days in myeloablative transplants. Recurrent CMV infections were observed only in patients receiving reduced intensity transplants. Using multivariate analysis only reduced intensity transplantation and in vivo T cell depletion had a significant impact on the risk of CMV infection. In our series the incidence for CMV infection following reduced intensity transplants seems to be increased as compared with risk-matched myeloablative transplants. When adding anti-T cell antibodies to the conditioning regimen, the risk for CMV infection increases by up to 75%. Thorough studies of the risk of post-transplant viral infection are necessary to optimize surveillance as well as pre-emptive and/or prophylactic treatment strategies in the non-myeloablative transplantation setting.
初步数据表明，由于受者T细胞的持续存在，非清髓性干细胞移植后免疫恢复更快，但对移植后感染并发症的实际影响仍不清楚。我们回顾性分析了20例接受白消安/氟达拉滨±噻替派进行减低剂量预处理及环孢素A/霉酚酸酯进行移植后免疫抑制的患者中巨细胞病毒（CMV）感染的发生率。将结果与同期接受清髓性移植且CMV风险组和供者来源相匹配的20例患者进行比较。减低剂量移植与清髓性移植后CMV感染的累积发生率分别为60.4%和40.0%（p值0.1，对数秩检验）。在用抗胸腺细胞球蛋白进行体内T细胞清除后，两个队列中CMV感染的风险均增加（分别为75%和60%）。在减低剂量移植后，急性移植物抗宿主病（GVHD）先于CMV感染诊断出现的时间中位数为25天（范围9 - 61天），在清髓性移植中为14天（范围10 - 34天）。仅在接受减低剂量移植的患者中观察到复发性CMV感染。使用多变量分析，仅减低剂量移植和体内T细胞清除对CMV感染风险有显著影响。在我们的系列研究中，与风险匹配的清髓性移植相比，减低剂量移植后CMV感染的发生率似乎有所增加。当在预处理方案中加入抗T细胞抗体时，CMV感染风险增加高达75%。有必要对移植后病毒感染风险进行深入研究，以优化非清髓性移植环境中的监测以及抢先和/或预防性治疗策略。
