早期巨细胞病毒血症与非清髓性造血细胞移植联合全身淋巴照射和抗胸腺细胞球蛋白预处理方案后病毒控制受损有关。
Early CMV viremia is associated with impaired viral control following nonmyeloablative hematopoietic cell transplantation with a total lymphoid irradiation and antithymocyte globulin preparative regimen.
机构信息
Division of Infectious Diseases, Stanford University Medical Center, Stanford, California 94305-5623, USA.
出版信息
Biol Blood Marrow Transplant. 2011 May;17(5):693-702. doi: 10.1016/j.bbmt.2010.08.010. Epub 2010 Aug 22.
The reconstitution of immune function after hematopoietic cell transplant (HCT) plays an important role in the control of viral infections. Both donor and recipient cytomegalovirus (CMV) serostatus has been shown to contribute to effective immune function; however, the influence of a nonmyeloablative preparative (NMA) regimen using total lymphoid irradiation (TLI) and antithymocyte globulin (ATG) on antiviral immune reconstitution has not yet been described. In 117 recipients of NMA HCT patients following ATG and TLI, not unexpectedly, CMV viremia was seen in approximately 60% of the seropositive patients regardless of donor serostatus, and recipient seropositivity significantly increased the odds of CMV viremia after transplant in a multivariate analysis. The administration of ATG and TLI resulted in a strikingly earlier viremia in the posttransplant period when compared to the previously reported timing of viremia following myeloablative preparative regimens, especially for transplant recipients who were seropositive for CMV with seronegative donors. Furthermore, early viremia in the setting of a CMV naïve donor was associated with a delay in functional antiviral control. These observations demonstrate the dynamic nature of immunity in relation to CMV antigen exposure in the complex environment resulting from NMA conditions where both donor and residual recipient immune response affect viral control.
造血细胞移植(HCT)后免疫功能的重建对于控制病毒感染起着重要作用。供者和受者的巨细胞病毒(CMV)血清状态都被证明有助于有效的免疫功能;然而,非清髓性预处理(NMA)方案使用全身淋巴照射(TLI)和抗胸腺细胞球蛋白(ATG)对抗病毒免疫重建的影响尚未描述。在 117 例接受 NMA HCT 后接受 ATG 和 TLI 的患者中,不出所料,约 60%的血清阳性患者出现 CMV 病毒血症,而在多变量分析中,受者的血清阳性状态显著增加了移植后 CMV 病毒血症的几率。与先前报道的清髓性预处理方案后病毒血症的时间相比,ATG 和 TLI 的使用导致移植后病毒血症出现的时间明显更早,特别是对于 CMV 血清阳性且供者血清阴性的移植受者。此外,在 CMV 未致敏供者的背景下出现早期病毒血症与抗病毒功能控制的延迟有关。这些观察结果表明,在 NMA 条件下,供者和残留受者的免疫反应都影响病毒控制,因此,与 CMV 抗原暴露相关的免疫具有动态性。