Green Jaime S, Shanley Ryan M, Brunstein Claudio G, Young Jo-Anne H, Verneris Michael R
Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Masonic Cancer Center Biostatistics Core, University of Minnesota, Minneapolis, Minnesota.
Transpl Infect Dis. 2019 Jun;21(3):e13070. doi: 10.1111/tid.13070. Epub 2019 Mar 29.
Recovery of cytomegalovirus (CMV)-specific immunity after hematopoietic cell transplantation (HCT) is essential in controlling CMV infection. We hypothesize that mixed donor engraftment as measured by chimerism at day 30 in CMV D(+) HCTs and full chimerism in CMV D(-) HCTs will be predictive of CMV reactivation. Prospectively collected data for 407 CMV R+ HCT recipients transplanted from 2006 to 2014 at the University of Minnesota were retrospectively analyzed. Full and mixed donor engraftment were defined as ≥95% or <95% donor cells at day 30, respectively. Source of engraftment determination included preferentially peripheral blood CD3 fraction, then myeloid cell fraction (CD15+), then bone marrow. In 407 CMV R+ subjects, 77% (n = 313) were CMV D(-) cells from umbilical cord blood (n = 209), peripheral blood (n = 58) or marrow (n = 46). Fifty three per cent received reduced intensity conditioning (RIC). At day +30, full donor engraftment was seen in 82% of myeloablative and 55% of RIC transplants. The cumulative incidence of CMV infection 1-year after transplant was not different in patients with full (54%, n = 276) or mixed (53%, n = 131) donor engraftment. Control of CMV did not significantly differ among the two groups. In multiple regression analysis, there was no significant association between donor engraftment (mixed or full) and incidence or control of CMV.
造血细胞移植（HCT）后巨细胞病毒（CMV）特异性免疫的恢复对于控制CMV感染至关重要。我们假设，在CMV D（+）HCT中第30天通过嵌合率测量的混合供体植入以及CMV D（-）HCT中的完全嵌合将预测CMV再激活。对2006年至2014年在明尼苏达大学接受移植的407例CMV R+ HCT受者的前瞻性收集数据进行了回顾性分析。完全和混合供体植入分别定义为第30天供体细胞≥95%或<95%。植入确定的来源优先包括外周血CD3部分，然后是髓样细胞部分（CD15+），然后是骨髓。在407例CMV R+受试者中，77%（n = 313）为来自脐带血（n = 209）、外周血（n = 58）或骨髓（n = 46）的CMV D（-）细胞。53%接受了减低强度预处理（RIC）。在第+30天，82%的清髓性移植和55%的RIC移植出现了完全供体植入。移植后1年CMV感染的累积发生率在完全（54%，n = 276）或混合（53%，n = 131）供体植入的患者中没有差异。两组之间CMV的控制没有显著差异。在多元回归分析中，供体植入（混合或完全）与CMV的发生率或控制之间没有显著关联。
