Department of Hematology, Karolinska University Hospital, and Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, The Netherlands.
Clin Infect Dis. 2014 Aug 15;59(4):473-81. doi: 10.1093/cid/ciu364. Epub 2014 May 20.
The use of a cytomegalovirus (CMV)-seronegative donor for a CMV-seronegative allogeneic hematopoietic stem cell transplant (HSCT) recipient is generally accepted. However, the importance of donor serostatus in CMV-seropositive patients is controversial.
A total of 49 542 HSCT patients, 29 349 seropositive and 20 193 seronegative, were identified from the European Group for Blood and Marrow Transplantation database. Cox multivariate models were fitted to estimate the effect of donor CMV serological status on outcome.
Seronegative patients receiving seropositive unrelated-donor grafts had decreased overall survival (hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.06-1.21; P < .0001) compared with seronegative donors, whereas no difference was seen in patients receiving HLA-matched sibling grafts. Seropositive patients receiving grafts from seropositive unrelated donors had improved overall survival (HR, 0.92; 95% CI, .86-.98; P < .01) compared with seronegative donors, if they had received myeloablative conditioning. This effect was absent when they received reduced-intensity conditioning. No effect was seen in patients grafted from HLA-identical sibling donors. The same association was found if the study was limited to patients receiving transplants from the year 2000 onward.
We confirm the negative impact on overall survival if a CMV-seropositive unrelated donor is selected for a CMV-seronegative patient. For a CMV-seropositive patient, our data support selecting a CMV-seropositive donor if the patient receives a myeloablative conditioning regimen.
使用巨细胞病毒（CMV）阴性供体进行 CMV 阴性同种异体造血干细胞移植（HSCT）受者通常是可以接受的。然而，CMV 阳性患者中供者血清学状态的重要性存在争议。
从欧洲血液和骨髓移植组数据库中确定了 49542 例 HSCT 患者，其中 29349 例为血清阳性，20193 例为血清阴性。使用 Cox 多变量模型来估计供者 CMV 血清学状态对结果的影响。
与阴性供体相比，接受阳性无关供体移植物的阴性患者总生存率降低（危险比[HR]，1.13；95%置信区间[CI]，1.06-1.21；P<0.0001），而接受 HLA 匹配的同胞供体移植物的患者则没有差异。接受阳性无关供体移植物且接受清髓性预处理的阳性患者总生存率提高（HR，0.92；95%CI，0.86-0.98；P<0.01），而接受强度降低预处理的患者则没有这种效果。在接受 HLA 相同的同胞供体移植物的患者中没有观察到这种效果。如果将研究仅限于 2000 年以后接受移植的患者，也会发现同样的关联。
我们确认了如果选择 CMV 阳性无关供体给 CMV 阴性患者，对总生存率的负面影响。对于 CMV 阳性患者，如果患者接受清髓性预处理方案，我们的数据支持选择 CMV 阳性供体。
