Department of Hematology, Sasebo City General Hospital, Sasebo, Japan.
Biol Blood Marrow Transplant. 2013 Apr;19(4):607-15. doi: 10.1016/j.bbmt.2013.01.011. Epub 2013 Jan 17.
Although allogeneic hematopoietic stem cell transplantation (allo-SCT) is performed as a curative option in adult T cell leukemia-lymphoma (ATL) patients, its high transplantation-related mortality raises a serious issue. The clinical features of infectious complications after transplantation are not well known. To analyze the impact of infections after allo-SCT for ATL, we retrospectively compared infectious complications in 210 patients at 3 institutions in Nagasaki prefecture between 1997 and 2009. There were 91 patients with acute myeloid leukemia (AML), 51 with acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL), and 68 with ATL. No patient received ganciclovir or foscarvir as prophylaxis, and most patients received antifungal prophylaxis with fluconazole or itraconazole. The cumulative incidence of cytomegalovirus (CMV) infection at 3 years was 69.2% in ATL patients versus 54.4% in AML patients (P = .0255). Cumulative infection-related mortality was significantly higher in ATL patients than in the 2 other groups (ATL versus AML, P = .0496; ATL versus ALL/LBL, P = .0075), and most death-causing pathogens were bacteria and fungus. The appearance of CMV infection was negatively associated with infectious mortality in ATL patients, but the P value for this association was near the borderline of significance (P = .0569). In multivariate analysis, transplantation using unrelated bone marrow and episodes of CMV infection were associated with worse overall survival in ATL patients, but were not in either AML or ALL/LBL patients. Collectively, the impact of infectious complications after transplantation in ATL patients was different from that in AML and ALL/LBL patients, suggesting that a more intensive strategy for infection control in ATL patients is required to reduce infectious mortality.
虽然异基因造血干细胞移植（allo-SCT）可作为成人 T 细胞白血病/淋巴瘤（ATL）患者的一种治愈选择，但由于其较高的移植相关死亡率，这仍是一个严重的问题。移植后感染并发症的临床特征尚不清楚。为了分析 allo-SCT 后感染对 ATL 的影响，我们回顾性比较了 1997 年至 2009 年在长崎县 3 家机构接受 allo-SCT 的 210 例 ATL 患者的感染并发症。91 例为急性髓系白血病（AML），51 例为急性淋巴细胞白血病/淋巴母细胞淋巴瘤（ALL/LBL），68 例为 ATL。没有患者接受更昔洛韦或膦甲酸钠作为预防用药，大多数患者接受氟康唑或伊曲康唑进行抗真菌预防。3 年时，CMV 感染的累积发生率在 ATL 患者中为 69.2%，而在 AML 患者中为 54.4%（P=0.0255）。ATL 患者的感染相关死亡率明显高于其他 2 组（ATL 与 AML，P=0.0496；ATL 与 ALL/LBL，P=0.0075），导致死亡的病原体主要是细菌和真菌。CMV 感染的出现与 ATL 患者的感染性死亡率呈负相关，但该相关性的 P 值接近显著水平（P=0.0569）。多变量分析显示，ATL 患者使用无关供体骨髓和 CMV 感染发作与总生存较差相关，但在 AML 或 ALL/LBL 患者中并非如此。总之，移植后感染并发症对 ATL 患者的影响与 AML 和 ALL/LBL 患者不同，提示需要采取更积极的感染控制策略来降低 ATL 患者的感染性死亡率。
