Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Biol Blood Marrow Transplant. 2019 Mar;25(3):587-593. doi: 10.1016/j.bbmt.2018.10.014. Epub 2018 Oct 22.
Viral infection is a serious complication that can greatly affect patient mortality and morbidity after allogenic hematopoietic stem cell transplantation (allo-HSCT). For the early identification of patients at high risk for viral infection, we evaluated the impact of lymphocyte area under the curve (AUC) value as a new predictive factor for early immune reconstitution after allo-HSCT against viral infection. This study included 286 patients who underwent their first allo-HSCT at Kyoto University Hospital between 2005 and 2017. Lymphocyte AUC from day 0 to day +15 was calculated in the analysis of human herpesvirus 6 (HHV-6), and lymphocyte AUC from day 0 to day +30 was calculated in the analysis of other viruses (cytomegalovirus [CMV], adenovirus, BK virus, JC virus, and varicella zoster virus). The risk factors for each viral reactivation/infection were assessed by multivariate analysis. The median age at transplantation was 51years (range, 17 to 68 years). The median lymphocyte AUC was 63/μL (range, 0 to 5620/μL) at day +15 and 3880 (range, 0 to 118,260/μL) at day +30. An increase in lymphocyte AUC was significantly associated with a high frequency of HHV-6 reactivation (P = .033) and a low frequency of CMV antigenemia (P = .014). No apparent association was found between lymphocyte AUC and reactivation/infection of other viruses. Aplastic anemia as a primary disease (hazard ratio [HR], 5.34; P < .001) and cord blood as a donor source (HR, 3.05; P = .006) were other risk factors for HHV-6 reactivation. Other risk factors for CMV antigenemia included the occurrence of acute graft-versus-host disease (HR 2.21; P < .001) and recipient age (HR 1.55; P = .017). Higher lymphocyte AUC at day +30 was significantly associated with low treatment-related mortality (HR, .47; P = .045). Lymphocyte AUC may be a good predictive factor for immune reconstitution against CMV reactivation. It also provides valuable information for predicting HHV-6 reactivation and treatment-related mortality.
病毒感染是一种严重的并发症，可极大地影响异基因造血干细胞移植（allo-HSCT）后的患者死亡率和发病率。为了早期识别病毒感染高危患者，我们评估了淋巴细胞曲线下面积（AUC）值作为 allo-HSCT 后早期免疫重建的新预测因子对病毒感染的影响。这项研究纳入了 2005 年至 2017 年期间在京都大学医院接受首次 allo-HSCT 的 286 名患者。在分析人类疱疹病毒 6（HHV-6）时，计算了从第 0 天到第 +15 天的淋巴细胞 AUC，在分析其他病毒（巨细胞病毒[CMV]、腺病毒、BK 病毒、JC 病毒和水痘带状疱疹病毒）时，计算了从第 0 天到第 +30 天的淋巴细胞 AUC。通过多变量分析评估了每种病毒再激活/感染的危险因素。移植时的中位年龄为 51 岁（范围 17-68 岁）。第 +15 天淋巴细胞 AUC 的中位数为 63/μL（范围 0-5620/μL），第 +30 天淋巴细胞 AUC 的中位数为 3880/μL（范围 0-118260/μL）。淋巴细胞 AUC 的增加与 HHV-6 再激活的高频率显著相关（P=.033），与 CMV 抗原血症的低频率显著相关（P=.014）。淋巴细胞 AUC 与其他病毒的再激活/感染之间没有明显的相关性。原发性疾病为再生障碍性贫血（风险比[HR]，5.34；P<.001）和脐带血作为供体来源（HR，3.05；P=.006）是 HHV-6 再激活的其他危险因素。CMV 抗原血症的其他危险因素包括急性移植物抗宿主病的发生（HR 2.21；P<.001）和受者年龄（HR 1.55；P=.017）。第 +30 天淋巴细胞 AUC 较高与治疗相关死亡率较低显著相关（HR，.47；P=.045）。淋巴细胞 AUC 可能是 CMV 再激活免疫重建的良好预测因子。它还为预测 HHV-6 再激活和治疗相关死亡率提供了有价值的信息。
