Instituto Nacional de Cancer, Centro de Transplante de Medula Óssea, Rio de Janeiro, Brazil.
Instituto Nacional de Cancer, Centro de Transplante de Medula Óssea, Rio de Janeiro, Brazil.
Biol Blood Marrow Transplant. 2020 Nov;26(11):e275-e279. doi: 10.1016/j.bbmt.2020.07.034. Epub 2020 Aug 1.
Cytomegalovirus (CMV) reactivation remains one of the main infectious complications following hematopoietic stem cell transplantation (HSCT). In this study, we explored the role of anti-CMV antibody titers in HSCT from alternative donors and to compare the risk of CMV reactivation between posttransplant cyclophosphamide-based haploidentical HSCT and antithymocyte globulin-based unrelated donor (URD) HSCT. We included 98 CMV-positive patients, 30 undergoing haploidentical HSCT and 68 undergoing URD HSCT. The majority of patients had a malignant disease (84%), received a myeloablative conditioning regimen (78%), and received a bone marrow graft (90%). The median pretransplantation anti-CMV IgG level was 109 U/mL. With median follow-up of 2.2 years, a total of 72 CMV reactivations occurred in 50 patients. There was no difference in CMV reactivation pattern between haploidentical HSCT recipients and URD HSCT recipients. In multivariable analysis until the first event, the incidence of CMV reactivation was higher in patients with anti-CMV IgG levels >100 U/mL (hazard ratio [HR], 2.38; P = .005) and in patients diagnosed with grade II-IV acute graft-versus-host disease (GVHD) (HR, 10.8; P = .003) after day +50 and lower in patients who received higher doses of CD34 cells (HR, .44; P = .006). In multivariable analysis for recurring events, the incidence of CMV reactivation was higher in patients receiving reduced-intensity conditioning (HR, 1.69: P = .04) and in patients with acute GVHD (HR, 1.88; P = .02), and lower in those who received higher doses of CD34 cells (HR, .55; P = .01). In summary, we have shown that pretransplantation anti-CMV IgG titers are correlated with CMV reactivation risk. More studies are needed to assess how this information can be incorporated in HSCT. The use of high-dose cellular grafts, a modifiable risk factor, also protects against CMV reactivation.
巨细胞病毒 (CMV) 再激活仍然是造血干细胞移植 (HSCT) 后主要的感染性并发症之一。在这项研究中，我们探讨了抗 CMV 抗体滴度在来自替代性供体的 HSCT 中的作用，并比较了移植后环磷酰胺为基础的半相合 HSCT 和抗胸腺细胞球蛋白为基础的无关供体 (URD) HSCT 之间 CMV 再激活的风险。我们纳入了 98 例 CMV 阳性患者，其中 30 例接受半相合 HSCT，68 例接受 URD HSCT。大多数患者患有恶性疾病 (84%)，接受了清髓性预处理方案 (78%)，并接受了骨髓移植 (90%)。移植前抗 CMV IgG 水平的中位数为 109 U/mL。中位随访 2.2 年后，50 例患者共发生 72 例 CMV 再激活。半相合 HSCT 受者和 URD HSCT 受者的 CMV 再激活模式无差异。多变量分析直至首次事件发生，抗 CMV IgG 水平 >100 U/mL 的患者 (风险比 [HR]，2.38；P =.005) 和移植后第 50 天以后诊断为 II-IV 级急性移植物抗宿主病 (GVHD) 的患者 (HR，10.8；P =.003) CMV 再激活的发生率较高，而接受较高剂量 CD34 细胞的患者 (HR，.44；P =.006) 则较低。在复发性事件的多变量分析中，接受强度降低的预处理的患者 (HR，1.69；P =.04) 和发生急性 GVHD 的患者 (HR，1.88；P =.02) CMV 再激活的发生率较高，而接受较高剂量 CD34 细胞的患者 (HR，.55；P =.01) 则较低。总之，我们已经表明，移植前抗 CMV IgG 滴度与 CMV 再激活风险相关。需要更多的研究来评估如何将这些信息纳入 HSCT。高剂量细胞移植物的使用是一个可改变的危险因素，也可预防 CMV 再激活。
