Nakamae Hirohisa, Kirby Katharine A, Sandmaier Brenda M, Norasetthada Lalita, Maloney David G, Maris Michael B, Davis Chris, Corey Lawrence, Storb Rainer, Boeckh Michael
Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA.
Biol Blood Marrow Transplant. 2009 Jun;15(6):694-703. doi: 10.1016/j.bbmt.2009.02.009. Epub 2009 Apr 16.
Nonmyeloablative conditioning is less toxic and results in initial establishment of mixed hematopoietic T cell chimerism for up to half a year with prolonged presence of host T cell immunity. In this study, we examined whether this translates into differences in the risks and/or severity of cytomegalovirus (CMV) infection and disease. We analyzed data from 537 nonmyeloablative (NM-HCT) and contemporaneous 2489 myeloablative hematopoietic cell transplant (M-HCT) recipients. In CMV seropositive recipients, no difference in the overall hazards of CMV infection at any level (adjusted hazard ratio [adj. HR] 0.9, 95% confidence interval [95% CI]: 0.7-1.0, P = .14) was noted; however, NM-HCT was associated with a lower risk of high-grade CMV infection (adj. HR 0.7, 95% CI: 0.5-0.9, P = .02). CMV disease rates were similar between the groups during the first 100 days after HCT, but NM-HCT recipients had an increased risk of late CMV disease (adj. HR 2.0, 95% CI 1.2-3.4). The increased risk of late CMV disease after NM-HCT was pronounced during the earlier years of the study period, but not detectable in more recent years. Contrary to earlier reports, survival following CMV disease was not reduced after NM-HCT when compared to M-HCT recipients. These results suggest that residual host cells after NM-HCT reduce progression to higher CMV viral load in NM-HCT recipients; however, this effect does not appear to protect against serious complications of CMV. Therefore, CMV prevention strategies in NM-HCT recipients should be similar to those used in M-HCT recipients.
非清髓性预处理毒性较小，可导致混合造血T细胞嵌合体初步建立长达半年，宿主T细胞免疫持续存在。在本研究中，我们研究了这是否会转化为巨细胞病毒（CMV）感染和疾病的风险和/或严重程度的差异。我们分析了537例接受非清髓性造血干细胞移植（NM-HCT）和同期2489例接受清髓性造血干细胞移植（M-HCT）受者的数据。在CMV血清学阳性受者中，未发现任何水平的CMV感染总体风险有差异（调整后风险比[adj. HR]为0.9，95%置信区间[95% CI]：0.7-1.0，P = 0.14）；然而，NM-HCT与高级别CMV感染风险较低相关（adj. HR为0.7，95% CI：0.5-0.9，P = 0.02）。HCT后前100天内两组的CMV疾病发生率相似，但NM-HCT受者发生晚期CMV疾病的风险增加（adj. HR为2.0，95% CI为1.2-3.4）。NM-HCT后晚期CMV疾病风险增加在研究期的早期较为明显，但近年来未检测到。与早期报告相反，与M-HCT受者相比，NM-HCT受者发生CMV疾病后的生存率并未降低。这些结果表明，NM-HCT后残留的宿主细胞可降低NM-HCT受者中CMV病毒载量进展至更高水平；然而，这种作用似乎并不能预防CMV的严重并发症。因此，NM-HCT受者的CMV预防策略应与M-HCT受者使用的策略相似。
