未干预的单倍体相合造血干细胞移植后单纯疱疹病毒 1/2 血症的危险因素和临床结局。

Risk factors for herpes simplex virus-1/2 viremia and clinical outcomes following unmanipulated haploidentical haematopoietic stem cell transplantation.

机构信息

Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.

Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.

出版信息

J Clin Virol. 2017 Oct;95:20-25. doi: 10.1016/j.jcv.2017.07.018. Epub 2017 Aug 4.

DOI:10.1016/j.jcv.2017.07.018

PMID:28837858

Abstract

BACKGROUND

Herpes simplex virus (HSV)-1/2 can still be reactivated after allogeneic haematopoietic stem cell transplantation (allo-HSCT) even when the prophylactic acyclovir is used. However, the risk factors for HSV-1/2 viremia and the clinical outcomes following unmanipulated haploidentical HSCT remain unknown.

OBJECTIVES AND STUDY DESIGN

Nineteen patients with HSV-1/2 viremia and fifty-seven patients without HSV-1/2 viremia which were selected using the case-pair method after undergoing haploidentical HSCT were enrolled. We analysed the risk factors for HSV-1/2 viremia and compared the clinical outcomes between the two groups.

RESULTS

The risk factors for HSV-1/2 viremia included HLA disparity ≥2 loci (p=0.049) and cytomegalovirus (CMV) reactivation (p=0.028). The incidences of platelet engraftment, oral mucositis and severe haemorrhagic cystitis (HC) in patients with and without HSV-1/2 viremia were 77% and 94% (p=0.003), 78% and 13% (p=0.000), and 25% and 6% (p=0.04), respectively. Moreover, the median time to platelet engraftment in patients with and without HSV-1/2 viremia was +25days (range, +11-+80) and +17days (range, +8-+67) (p=0.004), respectively. According to the multivariate analyses, HSV-1/2 viremia was associated with delayed platelet engraftment (p=0.038), a higher incidence of oral mucositis (p=0.000) and severe HC (p=0.038). However, HSV-1/2 viremia was not associated with non-relapse mortality (34.0% vs. 31.5%, p=0.26), leukaemia-free survival (60.9% vs. 57.9%, p=0.46) and overall survival (61.2% vs. 60.7%, p=0.37).

CONCLUSIONS

Based on our study results, we recommend that HSV-1/2 PCR should be performed upon clinical suspicion of HSV-1/2 infection.

摘要

背景

即使使用预防性阿昔洛韦，异基因造血干细胞移植（allo-HSCT）后单纯疱疹病毒 1/2（HSV-1/2）仍可再激活。然而，未处理的单倍体相合 HSCT 后 HSV-1/2 血症的危险因素和临床结局仍不清楚。

目的和研究设计

我们选择了 19 例 HSV-1/2 血症患者和 57 例无 HSV-1/2 血症患者进行配对分析，这些患者均接受了单倍体相合 HSCT。我们分析了 HSV-1/2 血症的危险因素，并比较了两组患者的临床结局。

结果

HSV-1/2 血症的危险因素包括 HLA 错配≥2 个位点（p=0.049）和巨细胞病毒（CMV）再激活（p=0.028）。有和无 HSV-1/2 血症的患者血小板植入、口腔粘膜炎和严重出血性膀胱炎（HC）的发生率分别为 77%和 94%（p=0.003）、78%和 13%（p=0.000）和 25%和 6%（p=0.04）。此外，有和无 HSV-1/2 血症的患者血小板植入的中位时间分别为+25 天（范围，+11-+80）和+17 天（范围，+8-+67）（p=0.004）。根据多变量分析，HSV-1/2 血症与血小板植入延迟相关（p=0.038），与口腔粘膜炎发生率较高（p=0.000）和严重 HC 相关（p=0.038）。然而，HSV-1/2 血症与非复发死亡率（34.0% vs. 31.5%，p=0.26）、白血病无病生存率（60.9% vs. 57.9%，p=0.46）和总生存率（61.2% vs. 60.7%，p=0.37）无关。