Diop Ndeye Soukeyna, Enok Bonong Pascal Roland, Buteau Chantal, Duval Michel, Lacroix Jacques, Laporte Louise, Tucci Marisa, Robitaille Nancy, Spinella Philip C, Cuvelier Geoffrey, Vercauteren Suzanne M, Lewis Victor, Alfieri Caroline, Trottier Helen
CHU Sainte-Justine Research Centre, Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC H3T 1C5, Canada.
CHU Sainte-Justine Research Centre, Department of Pediatrics, Division of Infectious Diseases, Université de Montréal, Montreal, QC H3T 1C5, Canada.
Vaccines (Basel). 2021 Jun 7;9(6):610. doi: 10.3390/vaccines9060610.
Epstein-Barr virus (EBV) and cytomegalovirus (CMV) infections can have serious consequences during the period of aplasia and lymphopenia following hematopoietic stem cell transplantation (HSCT). Large pediatric cohort studies examining the effect of antiviral prophylaxis against these viruses are scarce. The present study aimed to analyse the potential effect of antiviral prophylaxis (acyclovir and famciclovir) on active post-transplant EBV and CMV infection in a pediatric cohort of allogeneic HSCT recipients.
We used data from the TREASuRE cohort, consisting of 156 patients who had a first allogeneic HSCT, enrolled in four pediatric centers in Canada between July 2013 and March 2017. Follow-up was performed from the time of transplant up to 100 days post-transplant. Adjusted hazard ratio (HR) with 95% confidence intervals (CI) for the association between antiviral prophylaxis with acyclovir and/or famciclovir and EBV and CMV DNAemia was estimated using multivariate Cox regression models.
The post-transplant cumulative incidence of EBV and CMV DNAemia at 100 days of follow-up were, respectively, 34.5% (95% CI: 27.6-42.6) and 19.9% (95% CI: 14.5-27.1). For acyclovir, the adjusted hazard ratio (HR) for CMV and EBV DNAemia was 0.55 (95% CI: 0.24-1.26) and 1.41 (95% CI: 0.63-3.14), respectively. For famciclovir, the adjusted HR were 0.82 (95% CI: 0.30-2.29) and 0.79 (95% CI: 0.36-1.72) for CMV and EBV DNAemia, respectively.
The antivirals famciclovir and acyclovir did not reduce the risk of post-transplant CMV and EBV DNAemia among HSCT recipients in our pediatric population.
在造血干细胞移植（HSCT）后的再生障碍期和淋巴细胞减少期，爱泼斯坦-巴尔病毒（EBV）和巨细胞病毒（CMV）感染可能会产生严重后果。针对这些病毒进行抗病毒预防效果的大型儿科队列研究较少。本研究旨在分析抗病毒预防（阿昔洛韦和泛昔洛韦）对异基因HSCT儿童受者移植后活动性EBV和CMV感染的潜在影响。
我们使用了TREASuRE队列的数据，该队列由156例首次接受异基因HSCT的患者组成，于2013年7月至2017年3月在加拿大的四个儿科中心入组。从移植时开始随访直至移植后100天。使用多变量Cox回归模型估计阿昔洛韦和/或泛昔洛韦抗病毒预防与EBV和CMV病毒血症之间关联的调整风险比（HR）及95%置信区间（CI）。
随访100天时，移植后EBV和CMV病毒血症的累积发生率分别为34.5%（95%CI：27.6 - 42.6）和19.9%（95%CI：14.5 - 27.1）。对于阿昔洛韦，CMV和EBV病毒血症的调整风险比（HR）分别为0.55（95%CI：0.24 - 1.26）和1.41（95%CI：0.63 - 3.14）。对于泛昔洛韦，CMV和EBV病毒血症的调整HR分别为0.82（95%CI：0.30 - 2.29）和0.79（95%CI：0.36 - 1.72）。
在我们的儿科人群中，抗病毒药物泛昔洛韦和阿昔洛韦并未降低HSCT受者移植后CMV和EBV病毒血症的风险。
