Division of Pediatric Allergy, Immunology and Bone Marrow Transplantation, UCSF Benioff Children's Hospital, University of California, San Francisco, CA, USA.
Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy.
Transpl Infect Dis. 2021 Apr;23(2):e13504. doi: 10.1111/tid.13504. Epub 2020 Nov 29.
Cytomegalovirus (CMV) serostatus of recipient (R) and donor (D) influences hematopoietic stem cell transplant (HSCT) outcome. However, it is not a reliable indicator of CMV infection in primary immunodeficiency disorder (PIDD) recipients who are unable to make adequate antigen-specific immunoglobulin (Ig) or who receive intravenous Ig (IVIg) prior to testing.
Since no data exist on PIDD with unknown CMV serostatus, we aimed to evaluate the relationship between pre-HSCT recipient and donor serostatus and incidence of CMV infection in recipients with unknown serostatus.
A retrospective analysis of all pediatric PIDD HSCTs (2007-2018) was performed at University of California San Francisco. Recipients were separated into categories based on pre-transplant serostatus: 1) seropositive (R(+)), 2) seronegative (R(-)), and 3) unknown serostatus (R(x)). Patients with pre-HSCT active CMV viremia were excluded.
A total of 90 patients were included, 69% male. The overall incidence of CMV infection was 20%, but varied in R(+), R(-), and R(x) at 80%, 0%, and 14%, (P-value = .0001). Similarly, 5-year survival differed among groups, 60% R(+), 100% R(-), and 90% of R(x) (P-value = .0045). There was no difference in CMV reactivation by donor serostatus (P-value = .29), however, faster time to clearance of CMV was observed for R(x)/D(+) group (median 9.5 days (IQR 2.5-18), P-value = .024).
We identify a novel group of recipients, R(x), with an intermediate level of survival and CMV incidence post-HSCT, when compared to seropositive and seronegative recipients. No evidence of CMV transmission from D(+) in R(-) and R(x) was observed. We believe R(x) should be considered as a separate category in future studies to better delineate recipient risk status.
受者（R）和供者（D）的巨细胞病毒（CMV）血清状态影响造血干细胞移植（HSCT）的结果。然而，对于无法产生足够的抗原特异性免疫球蛋白（Ig）或在检测前接受静脉注射免疫球蛋白（IVIg）的原发性免疫缺陷病（PIDD）受者，CMV 血清状态并不是 CMV 感染的可靠指标。
由于缺乏对 CMV 血清状态未知的 PIDD 患者的相关数据，我们旨在评估 HSCT 前受者和供者的血清状态与 CMV 感染发生率之间的关系，以及 CMV 血清状态未知的受者的 CMV 感染发生率。
对 2007 年至 2018 年期间在加利福尼亚大学旧金山分校进行的所有儿科 PIDD HSCT 进行了回顾性分析。根据移植前的血清状态将受者分为以下几类：1）血清阳性（R(+)），2）血清阴性（R(-)），和 3）血清状态未知（R(x)）。排除了 HSCT 前有活动性 CMV 病毒血症的患者。
共纳入 90 例患者，其中 69%为男性。CMV 感染的总发生率为 20%，但在 R(+)、R(-)和 R(x)中分别为 80%、0%和 14%（P 值=0.0001）。同样，各组间的 5 年生存率也存在差异，分别为 60%的 R(+)、100%的 R(-)和 90%的 R(x)（P 值=0.0045）。供者的 CMV 再激活状态无差异（P 值=0.29），但 R(x)/D(+)组 CMV 清除速度更快（中位数为 9.5 天（IQR 2.5-18），P 值=0.024）。
与血清阳性和血清阴性受者相比，我们发现了一组新的 R(x)受者，他们在 HSCT 后具有中间水平的生存率和 CMV 发生率。未观察到 D(+)向 R(-)和 R(x)传播 CMV 的证据。我们认为 R(x)在未来的研究中应被视为一个单独的类别，以更好地区分受者的风险状态。
