Taimur S, Askar M, Sobecks R, Rybicki L, Warshawsky I, Mossad S
Department of Medicine, Division of Infectious Diseases and Immunology at NYU Langone Medical Center, NYU School of Medicine, New York, New York, USA.
Transpl Infect Dis. 2014 Feb;16(1):61-6. doi: 10.1111/tid.12163. Epub 2013 Nov 20.
Cytomegalovirus (CMV) is a common infection after myeloablative allogeneic hematopoietic stem cell transplant (M-alloHSCT). Achievement of complete donor T-cell chimerism (CDC-T) post transplant is a measure of immune reconstitution. We investigated the association between CDC-T post M-alloHSCT and the incidence of CMV viremia.
We retrospectively reviewed all CMV and chimerism results of 47 patients for the first 6 months post M-alloHSCT. CDC-T was analyzed as a time-varying covariate for association with post M-alloHSCT CMV viremia.
CMV viremia occurred in 15 (32%) and CDC-T was achieved in 38 (81%) recipients within the first 6 months post M-alloHSCT. On univariable analysis, increased CMV viremia was seen among patients with CDC-T (hazard ratio 2.81 [P = 0.07, 95% confidence interval = 0.93-8.52]). A 30-day landmark analysis showed that the incidence of CMV viremia at 6 months (regardless of recipient CMV serostatus) was 50% among those who had achieved CDC-T by day 30, and 23% among those who had not (P = 0.06).
We conclude that shorter time to CDC-T may be associated with higher risk of CMV viremia. If confirmed in a larger cohort, this might be a marker for risk stratification in the management of CMV in this population.
巨细胞病毒（CMV）是清髓性异基因造血干细胞移植（M-alloHSCT）后常见的感染。移植后实现完全供体T细胞嵌合（CDC-T）是免疫重建的一项指标。我们研究了M-alloHSCT后CDC-T与CMV病毒血症发生率之间的关联。
我们回顾性分析了47例患者在M-alloHSCT后前6个月的所有CMV和嵌合结果。将CDC-T作为一个随时间变化的协变量，分析其与M-alloHSCT后CMV病毒血症的关联。
15例（32%）患者发生了CMV病毒血症，38例（81%）受者在M-alloHSCT后前6个月内实现了CDC-T。单因素分析显示，在实现CDC-T的患者中CMV病毒血症增加（风险比2.81 [P = 0.07，95%置信区间 = 0.93 - 8.52]）。一项30天的标志性分析显示，在第30天实现CDC-T的患者中，6个月时CMV病毒血症的发生率（无论受者CMV血清学状态如何）为50%，未实现CDC-T的患者中为23%（P = 0.06）。
我们得出结论，达到CDC-T的时间较短可能与CMV病毒血症的较高风险相关。如果在更大的队列中得到证实，这可能是该人群CMV管理中风险分层的一个标志物。
