Verdonck L F, de Gast G C, van Heugten H G, Nieuwenhuis H K, Dekker A W
Department of Haematology, University Hospital Utrecht, The Netherlands.
Blood. 1991 Aug 1;78(3):844-8.
The pathogenic effect of cytomegalovirus (CMV) infection on the hematopoietic recovery after bone marrow transplantation (BMT) was retrospectively studied in 87 recipients of (nonpurged) autologous BMT and in 56 recipients of allogeneic BMT from HLA-identical siblings. Indications for autologous BMT were lymphomas or acute leukemias and for allogeneic BMT various malignancies or aplastic anemia. Patients were divided for the study in two groups, CMV-positive and CMV-negative on the basis of the CMV status pretransplant, and CMV-negative patients were kept CMV-negative by the local transfusion policy. In allogeneic BMT recipients, platelet recovery was significantly slower in CMV-positive patients than in CMV-negative patients (platelets greater than 50,000 cells/microL after 41 days v 27 days, P = .007). This difference held true when patients with acute graft-versus-host disease above grade I were excluded (platelets greater than 50,000 cells/microL after 42 days v 24 days, P = .01). In autologous BMT, the negative effect on platelet recovery was present in patients with lymphomas, but absent in patients with acute leukemias. Patients with acute leukemias had a very delayed recovery of platelets and granulocytes after autologous BMT, irrespective of the CMV status, probably due to the original stem cell disorder. Platelet recovery was significantly slower in CMV-positive autologous BMT recipients with lymphomas than in those not infected (platelets greater than 50,000 cells/microL after 36 days v 24 days, P = .0002). The presence of CMV infection had no effect on the recovery of granulocytes in autologous or allogeneic BMT. These data show that CMV infection causes delayed platelet recovery after BMT; however, in autologous BMT, the underlying disease (ie, acute leukemia) is more determinant for hematopoiesis after BMT.
对87例接受（未净化的）自体骨髓移植（BMT）的受者以及56例接受来自HLA匹配同胞的异基因BMT的受者进行回顾性研究，以探讨巨细胞病毒（CMV）感染对骨髓移植后造血恢复的致病作用。自体BMT的指征为淋巴瘤或急性白血病，异基因BMT的指征为各种恶性肿瘤或再生障碍性贫血。根据移植前的CMV状态，将患者分为CMV阳性和CMV阴性两组进行研究，并且通过当地输血政策使CMV阴性患者保持CMV阴性。在异基因BMT受者中，CMV阳性患者的血小板恢复明显慢于CMV阴性患者（41天后血小板大于50,000个细胞/微升对27天，P = 0.007）。当排除I级以上急性移植物抗宿主病的患者时，这种差异仍然存在（42天后血小板大于50,000个细胞/微升对24天，P = 0.01）。在自体BMT中，淋巴瘤患者存在对血小板恢复的负面影响，但急性白血病患者不存在。急性白血病患者自体BMT后血小板和粒细胞的恢复非常延迟，与CMV状态无关，这可能是由于原始干细胞疾病所致。CMV阳性的自体BMT淋巴瘤受者的血小板恢复明显慢于未感染的受者（36天后血小板大于50,000个细胞/微升对24天，P = 0.0002）。CMV感染的存在对自体或异基因BMT中粒细胞的恢复没有影响。这些数据表明，CMV感染导致BMT后血小板恢复延迟；然而，在自体BMT中，潜在疾病（即急性白血病）对BMT后的造血更具决定性作用。
