Clinic for Hematology and Oncology, Carl-Thiem-Klinikum, Cottbus, Germany.
Policlinico G.B. Rossi, Verona, Italy.
Ann Hematol. 2019 Jul;98(7):1755-1763. doi: 10.1007/s00277-019-03669-z. Epub 2019 Apr 16.
It has been shown recently that donor and/or recipient cytomegalovirus (CMV) seropositivity is associated with a significant overall survival (OS) decline in acute leukemia patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). We now analyzed the prognostic impact of the donor/recipient CMV serostatus in 6968 patients with chronic hematological malignancies who underwent allo-HSCT. Donor and/or recipient CMV seropositivity was associated with a significantly reduced 2-year progression-free survival (PFS, 50% vs. 52%, p = 0.03) and OS (62% vs. 65%, p = 0.01). Multivariate Cox regression analyses showed an independent negative prognostic impact of donor and/or recipient CMV seropositivity on PFS (HR, 1.1; 95% CI, 1.0-1.2; p = 0.03), OS (HR, 1.1; 95% CI, 1.0-1.2; p = 0.003), and non-relapse mortality (HR, 1.2; 95% CI, 1.0-1.3; p = 0.02). OS decline was strongest for CMV-seropositive recipients with a CMV-seronegative donor (HR, 1.2; 95% CI, 1.1-1.3), followed by CMV-seropositive patients with a CMV-seropositive donor (HR, 1.1; 95% CI, 1.0-1.2). Conversely, OS did not differ significantly between CMV-seronegative recipients allografted from a CMV-seropositive donor (HR, 1.0; 95% CI, 0.9-1.2) and patients with donor/recipient CMV seronegativity (p = 0.001 for the four groups together). Non-relapse mortality was also significantly (p = 0.01) higher for CMV-seropositive patients with a CMV-seronegative graft (HR, 1.2; 95% CI, 1.1-1.4) than for CMV-seropositive patients with a CMV-seropositive graft (HR, 1.1; 95% CI, 0.9-1.2) or CMV-seronegative recipients with a CMV-seropositive graft (HR, 1.0; 95% CI, 0.8-1.2). Donor and/or recipient CMV seropositivity still results in an OS decline in patients with chronic hematological malignancies who have undergone allo-HSCT. However, this OS decline seems to be lower than that described for acute leukemia patients previously.
最近的研究表明，供体和/或受者巨细胞病毒（CMV）血清阳性与接受异基因造血干细胞移植（allo-HSCT）的急性白血病患者的整体生存率（OS）显著下降有关。我们现在分析了 6968 例接受 allo-HSCT 的慢性血液恶性肿瘤患者的供体/受者 CMV 血清状态对预后的影响。供体和/或受者 CMV 血清阳性与显著降低的 2 年无进展生存率（PFS，50%对 52%，p=0.03）和 OS（62%对 65%，p=0.01）相关。多变量 Cox 回归分析显示，供体和/或受者 CMV 血清阳性对 PFS（HR，1.1；95%CI，1.0-1.2；p=0.03）、OS（HR，1.1；95%CI，1.0-1.2；p=0.003）和非复发死亡率（HR，1.2；95%CI，1.0-1.3；p=0.02）具有独立的负预后影响。对于 CMV 血清阳性的受者和 CMV 血清阴性的供者，OS 下降最为明显（HR，1.2；95%CI，1.1-1.3），其次是 CMV 血清阳性的患者和 CMV 血清阳性的供者（HR，1.1；95%CI，1.0-1.2）。相反，CMV 血清阴性的受者从 CMV 血清阳性的供者接受同种异体移植（HR，1.0；95%CI，0.9-1.2）与 CMV 血清阴性的供体/受者患者的 OS 无显著差异（p=0.001 用于四组比较）。CMV 血清阳性的患者和 CMV 血清阴性的移植物（HR，1.2；95%CI，1.1-1.4）的非复发死亡率也明显高于 CMV 血清阳性的患者和 CMV 血清阳性的移植物（HR，1.1；95%CI，0.9-1.2）或 CMV 血清阴性的患者和 CMV 血清阳性的移植物（HR，1.0；95%CI，0.8-1.2）。供体和/或受者 CMV 血清阳性仍然导致接受 allo-HSCT 的慢性血液恶性肿瘤患者的 OS 下降。然而，与之前描述的急性白血病患者相比，这种 OS 下降似乎较低。
