Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Blood. 2013 Aug 15;122(7):1316-24. doi: 10.1182/blood-2013-02-487074. Epub 2013 Jun 6.
The association between cytomegalovirus (CMV) reactivation and relapse was evaluated in a large cohort of patients with acute myeloid leukemia (AML) (n = 761), acute lymphoblastic leukemia (ALL) (n = 322), chronic myeloid leukemia (CML) (n = 646), lymphoma (n = 254), and myelodysplastic syndrome (MDS) (n = 371) who underwent allogeneic hematopoietic cell transplantation (HCT) between 1995 and 2005. In multivariable models, CMV pp65 antigenemia was associated with a decreased risk of relapse by day 100 among patients with AML (hazard ratio [HR] = 0.56; 95% confidence interval [CI], 0.3-0.9) but not in patients with ALL, lymphoma, CML, or MDS. The effect appeared to be independent of CMV viral load, acute graft-versus-host disease, or ganciclovir-associated neutropenia. At 1 year after HCT, early CMV reactivation was associated with reduced risk of relapse in all patients, but this did not reach significance for any disease subgroup. Furthermore, CMV reactivation was associated with increased nonrelapse mortality (HR = 1.31; 95% CI, 1.1-1.6) and no difference in overall mortality (HR = 1.05; 95% CI, 0.9-1.3). This report demonstrates a modest reduction in early relapse risk after HCT associated with CMV reactivation in a large cohort of patients without a benefit in overall survival.
在 1995 年至 2005 年间接受异基因造血细胞移植（HCT）的 761 例急性髓系白血病（AML）、322 例急性淋巴细胞白血病（ALL）、646 例慢性髓系白血病（CML）、254 例淋巴瘤和 371 例骨髓增生异常综合征（MDS）患者的大型队列中，评估了巨细胞病毒（CMV）再激活与复发之间的关系。在多变量模型中，CMV pp65 抗原血症与 AML 患者 100 天内复发风险降低相关（风险比[HR] = 0.56；95%置信区间[CI]，0.3-0.9），但在 ALL、淋巴瘤、CML 或 MDS 患者中则不然。这种作用似乎与 CMV 病毒载量、急性移植物抗宿主病或更昔洛韦相关中性粒细胞减少无关。HCT 后 1 年，早期 CMV 再激活与所有患者的复发风险降低相关，但在任何疾病亚组中均未达到显著水平。此外，CMV 再激活与非复发死亡率增加相关（HR = 1.31；95%CI，1.1-1.6），而总死亡率无差异（HR = 1.05；95%CI，0.9-1.3）。本报告显示，在无总体生存获益的情况下，在接受 HCT 的大量患者中，CMV 再激活与早期复发风险适度降低相关。
