Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China.
Collaborative Innovation Center of Hematology, Beijing 100044, China.
Clin Exp Immunol. 2022 Jun 23;208(3):332-339. doi: 10.1093/cei/uxac047.
Cytomegalovirus (CMV) infection and acute graft-versus-host disease (aGVHD) are two major complications that contribute to a poor prognosis after hematopoietic stem cell transplantation (HSCT). Superior early immune reconstitution (IR) is associated with improved survival after HSCT. However, when all three factors, CMV infection, aGVHD, and IR, are concomitantly considered, the effects of the triple events on HSCT are still unknown and should be studied further. Thus we enrolled 185 patients who were diagnosed as hematological malignancies and treated with HLA-matched sibling transplantation (MST) between January 2010 and December 2014, of whom 83 were positive for CMV infection and 82 had aGVHD. Results showed that patients with both aGVHD and CMV infection had significantly higher non-relapse mortality (NRM), lower overall survival (OS), and delayed CD8+ T-cell IR. Multivariate analyses showed that both aGVHD combined with CMV infection and delayed CD8+ T-cell IR were independent risk factors for prognosis post-MST. Recurrent CMV infections are associated with poor CD8+ T-cell reconstitution. However, superior IR could protect against the negative effects of aGVHD and CMV infection on the transplant outcomes.
巨细胞病毒(CMV)感染和急性移植物抗宿主病(aGVHD)是造血干细胞移植(HSCT)后导致预后不良的两个主要并发症。早期免疫重建(IR)良好与 HSCT 后生存改善相关。然而,当同时考虑 CMV 感染、aGVHD 和 IR 这三个因素时,三重事件对 HSCT 的影响仍不清楚,需要进一步研究。因此,我们纳入了 185 名 2010 年 1 月至 2014 年 12 月期间被诊断为血液系统恶性肿瘤并接受 HLA 匹配同胞移植(MST)的患者,其中 83 例 CMV 感染阳性,82 例发生 aGVHD。结果显示,同时发生 aGVHD 和 CMV 感染的患者非复发死亡率(NRM)显著更高,总生存率(OS)更低,CD8+T 细胞 IR 延迟。多变量分析显示,aGVHD 合并 CMV 感染和 CD8+T 细胞 IR 延迟是 MST 后预后的独立危险因素。CMV 再感染与 CD8+T 细胞重建不良有关。然而,良好的 IR 可以预防 aGVHD 和 CMV 感染对移植结果的负面影响。