Laboratoire de Virologie, CHU Nantes, Nantes, France.
Laboratoire de Virologie, CHU Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM, Université de Nantes, Nantes, France; Institut de Transplantation urologie Néophrologie (ITUN), CHU Nantes, Nantes, France.
J Clin Virol. 2017 Aug;93:30-36. doi: 10.1016/j.jcv.2017.05.019. Epub 2017 May 31.
Viral infections are well-known complications after allogeneic stem cell transplant (allo-SCT).
We compared prospectively incidences of DNAemia and active infections (AI) for five opportunistic viruses (Human Herpesvirus 6 (HHV-6), Epstein-Barr virus (EBV), BK polyomavirus (BKPyV), Cytomegalovirus (CMV) and Adenovirus (ADV)) and kinetics of immune reconstitution (IR) in adults receiving either double umbilical cord blood (dUCB group) or unrelated peripheral blood stem cell (uPBSC group) allo-SCT after a reduced-intensity conditioning (RIC) regimen.
Whole blood samples were collected at transplant, every 15days during the first 3 months and at 4, 5 and 6 months post-transplant.
Sixty-five patients were enrolled (uPBSC n=34; dUCB n=31). Incidences of HHV-6 and BKPyV DNAemia were significantly higher for dUCB (97% vs 23.5% and 58% vs 32%, respectively) while EBV DNAemia was more frequently detected in uPBSC (71% vs 26%). The incidence of CMV DNAemia was similar between both groups. ADV AI developed only in dUCB. HHV-6 AI were also higher in dUCB (84% vs 21%). In multivariate analysis, dUCB graft was the only independent factor associated with HHV-6 DNAemia (OR: 19.0; 95%CI: 5.2-69.1; p<0.0001) while EBV DNAemia were significantly associated with uPBSC (OR: 29.9; 95%CI: 5.68-158; p <0.0001). dUCB graft was also the only factor associated with HHV-6 AI. Finally, higher counts and faster recoveries of B lymphocytes (p<0.0001) and monocytes (p=0.0007) were observed in the dUCB group.
We demonstrate a strong correlation between sources of graft and patterns of viral DNAemia and AI and IR after RIC allo-SCT.
病毒感染是异基因造血干细胞移植（allo-SCT）后的已知并发症。
我们前瞻性比较了 5 种机会性病毒（人类疱疹病毒 6（HHV-6）、EB 病毒（EBV）、BK 多瘤病毒（BKPyV）、巨细胞病毒（CMV）和腺病毒（ADV））的 DNA 血症和活动性感染（AI）的发生率，以及接受强化预处理方案的成人接受双脐血（dUCB 组）或无关外周血造血干细胞（uPBSC 组）allo-SCT 后免疫重建（IR）的动力学。
在移植时、前 3 个月每 15 天以及移植后 4、5 和 6 个月采集全血样本。
共纳入 65 例患者（uPBSC n=34；dUCB n=31）。dUCB 组 HHV-6 和 BKPyV DNA 血症的发生率明显更高（97% vs 23.5%和 58% vs 32%），而 EBV DNA 血症在 uPBSC 组更常见（71% vs 26%）。两组 CMV DNA 血症的发生率相似。ADV AI 仅在 dUCB 中发展。dUCB 移植物也是 HHV-6 AI 的唯一独立相关因素（OR：19.0；95%CI：5.2-69.1；p<0.0001），而 EBV DNA 血症与 uPBSC 显著相关（OR：29.9；95%CI：5.68-158；p<0.0001）。dUCB 移植物也是 HHV-6 AI 的唯一相关因素。最后，在 dUCB 组中观察到 B 淋巴细胞（p<0.0001）和单核细胞（p=0.0007）计数更高且更快恢复。
我们证明了 RIC allo-SCT 后，移植物来源与病毒 DNA 血症和 AI 以及 IR 之间存在很强的相关性。
