Department of Anesthesiology and Intensive Care, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, Antoni Jurasz University Hospital No.1, Bydgoszcz, Poland.
Department of Hematology and Hematopoietic Cell Transplantation, Medical University, Poznan, Poland.
Ann Hematol. 2021 Mar;100(3):763-777. doi: 10.1007/s00277-021-04428-9. Epub 2021 Jan 25.
Allogeneic hematopoietic cell transplant (allo-HCT) is a potentially curative therapeutic strategy that showed encouraging long-term outcomes in hematological diseases. A number of factors can influence post-transplant clinical outcomes. While Epstein-Barr virus (EBV) constitutes a trigger for development of various adverse conditions, no clinical study yet has been powered to assess the effect of EBV serostatus on the clinical outcomes in allo-HCT population. To systematically summarize and analyze the impact of donor and recipient EBV serostatus on transplant outcomes in allo-HCT recipients, meta-analyses were conducted. Selected endpoints were overall survival (OS), relapse-free survival (RFS), relapse incidence (RI), non-relapse mortality (NRM), acute graft-versus-host disease (aGVHD), chronic graft-versus-host disease (cGVHD), and de novo cGVHD. Three studies with 26,650 patients, transplanted for acute leukemias, lymphomas, chronic hematological malignancies, or non-malignant hematological diseases were included in the meta-analysis. In the whole population, with a total of 53,300 donors and recipients, the rate of EBV seropositivity was 85.1%, including 86.6% and 83.6% among transplant recipients and healthy donors, respectively. Donor EBV seropositivity increased the risk of cGVHD by 17%, de novo cGVHD by 14%, and aGHVD by 5%. Recipient EBV seropositivity increased the risk of cGVHD by 12%, de novo cGVHD by 17%; increased NRM by 11%, increased RI by 11%, decreased OS by 14%, and decreased RFS by 11%. In performed meta-analyses, donor and recipient EBV seropositivity was found to have a significant impact on transplant outcomes in patients after allo-HCT.
异基因造血细胞移植（allo-HCT）是一种潜在的根治性治疗策略，在血液系统疾病中显示出令人鼓舞的长期疗效。许多因素会影响移植后的临床结果。虽然 EBV 是引发各种不良情况的一个因素，但目前尚无临床研究能够评估 EBV 血清状态对 allo-HCT 人群临床结局的影响。为了系统地总结和分析供体和受者 EBV 血清状态对 allo-HCT 受者移植结果的影响，进行了荟萃分析。选择的终点是总生存率（OS）、无复发生存率（RFS）、复发率（RI）、非复发死亡率（NRM）、急性移植物抗宿主病（aGVHD）、慢性移植物抗宿主病（cGVHD）和新发 cGVHD。共有三项研究纳入了 26650 例接受急性白血病、淋巴瘤、慢性血液系统恶性肿瘤或非恶性血液病移植的患者，进行了荟萃分析。在整个人群中，共有 53300 名供体和受者，EBV 血清阳性率为 85.1%，包括移植受者和健康供体的分别为 86.6%和 83.6%。供体 EBV 血清阳性增加了 cGVHD 的风险 17%、新发 cGVHD 的风险 14%和 aGHVD 的风险 5%。受者 EBV 血清阳性增加了 cGVHD 的风险 12%、新发 cGVHD 的风险 17%；增加了 NRM 11%、RI 增加了 11%、OS 减少了 14%和 RFS 减少了 11%。在进行的荟萃分析中，发现供体和受者 EBV 血清阳性对 allo-HCT 后患者的移植结果有显著影响。
