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移植后环磷酰胺与巨细胞病毒感染增加有关:CIBMTR 分析。

Posttransplant cyclophosphamide is associated with increased cytomegalovirus infection: a CIBMTR analysis.

机构信息

Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis MO.

Division of Hematology/Oncology and.

出版信息

Blood. 2021 Jun 10;137(23):3291-3305. doi: 10.1182/blood.2020009362.

Abstract

Prior studies suggest increased cytomegalovirus (CMV) infection after haploidentical donor transplantation with posttransplant cyclophosphamide (HaploCy). The role of allograft source and posttransplant cyclophosphamide (PTCy) in CMV infection is unclear. We analyzed the effect of graft source and PTCy on incidence of CMV infection, and effects of serostatus and CMV infection on transplant outcomes. We examined patients reported to the Center for International Blood and Marrow Transplantation Research between 2012 and 2017 who had received HaploCy (n = 757), matched related (Sib) with PTCy (SibCy, n = 403), or Sib with calcineurin inhibitor-based prophylaxis (SibCNI, n = 1605). Cumulative incidences of CMV infection by day 180 were 42%, 37%, and 23%, respectively (P < .001). CMV disease was statistically comparable. CMV infection risk was highest for CMV-seropositive recipients (R+), but significantly higher in PTCy recipients regardless of donor (HaploCy [n = 545]: hazard ratio [HR], 50.3; SibCy [n = 279]: HR, 47.7; SibCNI [n = 1065]: HR, 24.4; P < .001). D+/R- patients also had increased risk for CMV infection. Among R+ or those developing CMV infection, HaploCy had worse overall survival and nonrelapse mortality. Relapse was unaffected by CMV infection or serostatus. PTCy was associated with lower chronic graft-versus-host disease (GVHD) overall, but CMV infection in PTCy recipients was associated with higher chronic GVHD (P = .006). PTCy, regardless of donor, is associated with higher incidence of CMV infection, augmenting the risk of seropositivity. Additionally, CMV infection may negate the chronic GVHD protection of PTCy. This study supports aggressive prevention strategies in all receiving PTCy.

摘要

先前的研究表明,在接受haploidentical 供体移植后(使用 posttransplant cyclophosphamide,HaploCy),巨细胞病毒(CMV)感染的风险增加。同种异体移植物来源和 posttransplant cyclophosphamide(PTCy)在 CMV 感染中的作用尚不清楚。我们分析了移植物来源和 PTCy 对 CMV 感染发生率的影响,以及 CMV 感染对移植结果的影响。我们检查了 2012 年至 2017 年期间向国际血液和骨髓移植研究中心报告的接受 HaploCy(n = 757)、接受 PTCy 治疗的匹配相关供体(SibCy,n = 403)或接受钙调神经磷酸酶抑制剂为基础的预防治疗的匹配相关供体(SibCNI,n = 1605)的患者。第 180 天的 CMV 感染累积发生率分别为 42%、37%和 23%(P <.001)。CMV 疾病的统计学结果相似。CMV 感染风险在 CMV 血清阳性(R+)受者中最高,但在无论供体如何(HaploCy [n = 545]:风险比 [HR],50.3;SibCy [n = 279]:HR,47.7;SibCNI [n = 1065]:HR,24.4;P <.001)的 PTCy 受者中更高。D+/R-患者也有增加 CMV 感染的风险。在 R+或发生 CMV 感染的患者中,HaploCy 的总生存率和非复发死亡率较低。复发不受 CMV 感染或血清学状态的影响。PTCy 总体上与较低的慢性移植物抗宿主病(GVHD)相关,但 PTCy 受者的 CMV 感染与更高的慢性 GVHD 相关(P =.006)。无论供体如何,PTCy 都与 CMV 感染发生率增加相关,增加了血清阳性的风险。此外,CMV 感染可能否定了 PTCy 对慢性 GVHD 的保护作用。这项研究支持对所有接受 PTCy 治疗的患者采取积极的预防策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c68e/8351903/db5430e81350/bloodBLD2020009362absf1.jpg

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