巨细胞病毒和爱泼斯坦-巴尔病毒共同激活的异基因造血干细胞移植患者的临床结局
[Clinical outcomes of allogeneic hematopoietic stem cell transplantation patients with co-activation of cytomegalovirus and Epstein-Barr virus].
作者信息
Song Tiemei, Chen Guanghua, Zhang Xiang, Xu Yang, Chen Jia, Wang Ying, Ye Linlin, Xu Jing, Wu Depei, Miao Jingcheng
机构信息
Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, Key Laboratory of Thrombosis and Hemostasis under Ministry of Health, Suzhou 215006, China.
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出版信息
Zhonghua Yi Xue Za Zhi. 2014 Nov 4;94(40):3135-9.
OBJECTIVE
To evaluate the impact of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) co-activation on the prognosis of allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients.
METHODS
We retrospectively analyzed 330 consecutive allo-HSCT patients at First Affiliated Hospital of Soochow University from December 2011 to August 2013. CMV and EBV DNA were regularly monitored by quantitative polymerase chain reaction (PCR) from the engraftment of granuloCyte within one year after transplantation. The incidences of viremia and clinical outcomes were analyzed by χ(2) test and Kaplan-Meier analysis.
RESULTS
After a median follow-up period of 16 (7-25) months, a total of 113 (34.2%) patients were identified with CMV viremia (CMV+) alone, 82 (24.8%) with EBV viremia (EBV+) alone and 32 (9.7%) with CMV and EBV co-activation (CMV/EBV+). The proportion of patients undergoing HLA mismatched transplantation and ones with acute graft-versus-host disease (aGVHD) in CMV/EBV+ group was significantly higher than CMV+ group or EBV+ group (78.1% (25/32) vs 58.5% (48/82) or 50.4% (57/113), P = 0.047,0.008; 56.3% (18/32) vs 32.9% (27/82) or 34.5% (39/113) , P = 0.022, 0.026) . The incidence of post-transplant lymphoproliferative disorder (PTLD) was similar to EBV+ group (12.5% (4/32) vs 11.0% (9/82) , P = 0.802) and so did the incidence of CMV disease when compared with CMV+ group (9.4% (3/32) vs 7.1% (8/113) , P = 0.665). The 2-year overall survival (OS) of CMV+, EBV+ and CMV/EBV+ groups was 68.7%, 61.5% and 62.4% respectively. And no significant difference existed between CMV/EBV+ and the other two groups (P = 0.598, 0.717). However, the 6-month non-relapse mortality (NRM) of CMV/EBV+ group was significantly higher than that of CMV+ or EBV+ group (18.7% vs 8.9%, P = 0.036; 18.7% vs 8.1%, P = 0.032).
CONCLUSIONS
HLA mismatch transplants and aGVHD are frequent in CMV and EBV co-activation group. When compared with EBV+ or CMV+ patients, the CMV/EBV+ patients have similar incidence of PTLD or CMV disease and 2-year OS.However, the 6-month NRM is significantly higher in CMV/EBV+ group. It suggests that CMV and EBV co-activation is a risk factor for early mortality of allo-HSCT patients.
目的
评估巨细胞病毒（CMV）和EB病毒（EBV）共同激活对异基因造血干细胞移植（allo-HSCT）患者预后的影响。
方法
回顾性分析2011年12月至2013年8月在苏州大学附属第一医院连续进行的330例allo-HSCT患者。移植后1年内，自粒细胞植入起，通过定量聚合酶链反应（PCR）定期监测CMV和EBV DNA。采用χ(2)检验和Kaplan-Meier分析方法分析病毒血症的发生率和临床结局。
结果
中位随访期为16（7 - 25）个月，共113例（34.2%）患者仅发生CMV病毒血症（CMV+），82例（24.8%）仅发生EBV病毒血症（EBV+），32例（9.7%）发生CMV和EBV共同激活（CMV/EBV+）。CMV/EBV+组中接受HLA错配移植的患者比例和发生急性移植物抗宿主病（aGVHD）的患者比例显著高于CMV+组或EBV+组（78.1%（25/32）对58.5%（48/82）或50.4%（57/113），P = 0.047，0.008；56.3%（18/32）对32.9%（27/82）或34.5%（39/113），P = 0.022，0.026）。移植后淋巴细胞增殖性疾病（PTLD）的发生率与EBV+组相似（12.5%（4/32）对11.0%（9/82），P = 0.802），与CMV+组相比，CMV疾病的发生率也相似（9.4%（3/32）对7.1%（8/113），P = 0.665）。CMV+组、EBV+组和CMV/EBV+组的2年总生存率（OS）分别为68.7%、61.5%和62.4%。CMV/EBV+组与其他两组之间无显著差异（P = 0.598，0.7,17）。然而，CMV/EBV+组的6个月非复发死亡率（NRM）显著高于CMV+组或EBV+组（18.7%对8.9%，P = 0.036；18.7%对8.1%，P = 0.032）。
结论
CMV和EBV共同激活组中HLA错配移植和aGVHD较为常见。与EBV+或CMV+患者相比，CMV/EBV+患者的PTLD或CMV疾病发生率及2年总生存率相似。然而，CMV/EBV+组的6个月非复发死亡率显著更高。这表明CMV和EBV共同激活是allo-HSCT患者早期死亡危险因素。
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