Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
Division of Blood Transfusion, Shinshu University Hospital, Matsumoto, Japan.
Transfusion. 2019 Oct;59(10):3065-3070. doi: 10.1111/trf.15456. Epub 2019 Jul 19.
Leukoreduced blood components have been widely implemented to prevent transfusion-transmitted cytomegalovirus (TT-CMV) in transplantation. Recent progress in leukoreduction technology has helped reduce the risk of TT-CMV in hematopoietic stem cell transplantation; however, its efficacy in umbilical cord blood transplantation (CBT) has not been systematically studied.
We retrospectively analyzed the incidence of CMV infection in patients treated with CBT who received prestorage leukoreduced, CMV-unselected blood components between 2007 and 2017 in a single Japanese pediatric center. Patients were monitored for CMV antigenemia at least once weekly.
In total, 71 patients treated with CBT were identified. Two patients were excluded because of unknown CMV serostatus or early death after CBT. Of the remaining 69 patients, 24 developed CMV antigenemia. Among them, 3 received granulocyte transfusions (3 of 3; 100%), 2 were infants with severe combined immunodeficiency who had been infected with CMV before CBT (2 of 2; 100%), and 19 were CMV-seropositive patients (19 of 23, 82.6%). Conversely, of the remaining 45 patients in whom CMV antigenemia did not develop, 41 were seronegative (0 of 41; 0%) and were transfused with a total of 925 leukoreduced, CMV-unselected blood components. Among the 41 patients, 9 (22%) received in vivo T-cell depletion with antithymocyte globulin. None of the patients in the seronegative group has subsequently shown evidence of CMV infection or developed CMV disease.
Using prestorage leukoreduction, no cases of CMV infection were detected in seronegative CBT patients. Our findings showed the safety of leukoreduction in preventing TT-CMV in this patient group.
减少白细胞的血液成分已广泛应用于预防移植中的输血传播巨细胞病毒（TT-CMV）。最近在减少白细胞技术方面的进展有助于降低造血干细胞移植中 TT-CMV 的风险；然而，其在脐带血移植（CBT）中的疗效尚未得到系统研究。
我们回顾性分析了 2007 年至 2017 年间在日本的一家儿科中心接受储存前减少白细胞、CMV 未选择的血液成分治疗的 CBT 患者的 CMV 感染发生率。患者每周至少监测一次 CMV 抗原血症。
共确定了 71 例接受 CBT 的患者。由于 CMV 血清学状态未知或 CBT 后早期死亡，有 2 例患者被排除在外。在其余 69 例患者中，有 24 例发生 CMV 抗原血症。其中，3 例接受了粒细胞输注（3 例中的 3 例；100%），2 例为在 CBT 前已感染 CMV 的严重联合免疫缺陷婴儿（2 例中的 2 例；100%），19 例为 CMV 血清阳性患者（23 例中的 19 例；82.6%）。相反，在其余 45 例未发生 CMV 抗原血症的患者中，41 例为血清阴性（41 例中的 0 例；0%），共输注了 925 份储存前减少白细胞、CMV 未选择的血液成分。在 41 例血清阴性患者中，有 9 例（22%）接受了抗胸腺细胞球蛋白的体内 T 细胞耗竭。在血清阴性组中，没有患者随后出现 CMV 感染的证据或发展为 CMV 疾病。
在血清阴性的 CBT 患者中，使用储存前减少白细胞的方法未检测到 CMV 感染。我们的研究结果表明，减少白细胞在预防该患者群体中的 TT-CMV 方面是安全的。
