Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, New Children's Hospital, Helsinki University Hospital , Helsinki , Finland.
Faculty of Medicine, University of Helsinki , Helsinki , Finland.
Infect Dis (Lond). 2019 Oct;51(10):772-778. doi: 10.1080/23744235.2019.1650198. Epub 2019 Aug 5.
Viral infections are a major cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Although immune suppression plays a central role, the literature shows conflicting results on interplay between post-transplant immune reconstitution (IR) and viral infections. We prospectively studied viral infections and IR in 30 pediatric patients undergoing allogenic HSCT, with a follow-up time of 24 months. In total, 1337 blood (CMV, EBV, HHV-6, ADV and BKV) and urine (BKV and JCV) virus samples were analyzed. IR including B-cells (CD19+), T cells (CD3+, CD4+, CD8+) and NK-cells were measured. Clinical outcomes included overall survival (OS), non-relapse mortality (NRM), graft-versus-host disease (GVHD) and occurrence of blood culture positive bacterial infections. We found BKV reactivation to be most frequent, 47% of the children had viremia and 77% viruria. The frequencies of CMV, HHV-6 and adeno viremia were 37%, 37% and 6%, respectively. Viremias beyond 3 months post-HSCT were uncommon. Factors such as GVHD, use of steroids, EBV and CMV infections and pre-transplant irradiation affected IR. No specific viral infection or IR related factor was associated to OS or NRM. Viral infections and IR interact in a bi-directional manner. Accordingly, close follow-up of both IR and viral loads is warranted.
病毒感染是造血干细胞移植（HSCT）后发病率和死亡率的主要原因。尽管免疫抑制起着核心作用，但文献中关于移植后免疫重建（IR）与病毒感染之间的相互作用存在相互矛盾的结果。我们前瞻性研究了 30 名接受异基因 HSCT 的儿科患者的病毒感染和 IR，随访时间为 24 个月。共分析了 1337 份血液（CMV、EBV、HHV-6、ADV 和 BKV）和尿液（BKV 和 JCV）病毒样本。IR 包括 B 细胞（CD19+）、T 细胞（CD3+、CD4+、CD8+）和 NK 细胞。临床结果包括总生存率（OS）、非复发死亡率（NRM）、移植物抗宿主病（GVHD）和血培养阳性细菌感染的发生。我们发现 BKV 再激活最为常见，47%的患儿出现病毒血症，77%出现病毒尿症。CMV、HHV-6 和腺病毒血症的频率分别为 37%、37%和 6%。HSCT 后 3 个月以上的病毒血症并不常见。GVHD、使用类固醇、EBV 和 CMV 感染以及移植前照射等因素影响了 IR。没有特定的病毒感染或与 IR 相关的因素与 OS 或 NRM 相关。病毒感染和 IR 以双向方式相互作用。因此，需要密切监测 IR 和病毒载量。
