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HLA-DP 错配和 CMV 再激活独立增加异基因干细胞移植受者发生移植物抗宿主病的风险。

HLA-DP mismatch and CMV reactivation increase risk of aGVHD independently in recipients of allogeneic stem cell transplant.

机构信息

Department of Medicine, Washington University School of Medicine, St Louis, MO 63110, USA.

The University of Texas MD Anderson Cancer Center, Department of Biostatistics, Houston, TX, USA.

出版信息

Curr Res Transl Med. 2019 May;67(2):51-55. doi: 10.1016/j.retram.2019.01.001. Epub 2019 Jan 23.

Abstract

HLA-DP mismatched allogeneic hematopoietic stem cell transplantation (allo-HCT) is associated with increased risk of aGVHD and decreased risk of relapse with no effects on overall survival (OS). It has been proposed that CMV-reactivation induces expression of HLA-DP molecules on GVHD target tissues by releasing inflammatory cytokines. We hypothesized that the increased GVHD incidence in HLA-DP mismatched allo-SCTs correlates with recipient CMV serostatus or CMV reactivation. In addition, CMV reactivation is associated with increased risk of GVHD with an unknown mechanism. Here, we analyzed the association between HLA-DPB1 and CMV reactivation on cumulative incidence of aGVHD and relapse as well as OS in 613 patients with AML and MDS who underwent matched related or unrelated allo-HCT at MD Anderson Cancer Center from 2005 to 2011. In multivariable analysis, HLA-DPB1 mismatching was associated with increased risk of aGVHD (hazard ratio (HR): 1.53, P < 0.001) independent of CMV serostatus and CMV reactivation. Additionally, HLA-DPB1 mismatching was associated with decreased risk of relapse and no effect on OS. CMV reactivation increased risks of aGVHD (HR: 5.82, P < 0.001) independent of HLA-DP mismatching with no effect on relapse or OS. In conclusion, our data suggests that HLA-DPB1 mismatching and CMV reactivation increase risk of aGVHD independently.

摘要

HLA-DP 错配的异基因造血干细胞移植(allo-HCT)与 aGVHD 的风险增加和复发风险降低相关,而对总生存(OS)无影响。据推测,CMV 再激活通过释放炎症细胞因子诱导 GVHD 靶组织中 HLA-DP 分子的表达。我们假设 HLA-DP 错配的 allo-SCT 中 GVHD 发生率增加与受者 CMV 血清状态或 CMV 再激活相关。此外,CMV 再激活与 GVHD 风险增加相关,但具体机制尚不清楚。在这里,我们分析了 613 例 AML 和 MDS 患者在 MD 安德森癌症中心接受匹配相关或无关 allo-HCT 时,HLA-DPB1 与 CMV 再激活与 aGVHD 累积发生率、复发和 OS 之间的关系。多变量分析显示,HLA-DPB1 错配与 aGVHD 风险增加相关(风险比(HR):1.53,P<0.001),与 CMV 血清状态和 CMV 再激活无关。此外,HLA-DPB1 错配与复发风险降低相关,对 OS 无影响。CMV 再激活增加了 aGVHD 的风险(HR:5.82,P<0.001),与 HLA-DP 错配无关,对复发或 OS 无影响。总之,我们的数据表明,HLA-DPB1 错配和 CMV 再激活独立增加 aGVHD 的风险。

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