Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
Department of Ophthalmology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
Front Cell Infect Microbiol. 2022 May 25;12:900154. doi: 10.3389/fcimb.2022.900154. eCollection 2022.
Delayed immune reconstitution after allogeneic hematopoietic stem cell transplantation (HSCT) is significantly associated with cytomegalovirus (CMV) infection. The aim of this study was to observe the recovery trend of peripheral lymphocyte subsets and immunoglobulins in HSCT recipients who developed CMV retinitis (CMVR).
We identified 37 CMVR cases and 303 non-CMVR controls in this case-control study from a database of 404 consecutive severe aplastic anemia patients who received allogeneic HSCT at a single center between 2015 and 2020. We analyzed the transplant outcomes and immune reconstitution principles with a focus on lymphocyte CD series and immunoglobulin series within the first year post-HSCT.
Thirty-seven patients (55 eyes) were diagnosed with CMVR, with a mean onset time of 155 days post-HSCT. Among the 37 patients, one never had CMV detected in his blood but had a high CMV load in his intraocular fluid at the time of CMVR diagnosis. In the controls, 195 had CMV viremia and 108 did not. Compared with controls, CMVR cases had a longer duration of CMV viremia and a higher peak number of CMV load. T lymphocyte subsets including CD3, CD4 and CD8 were significantly lower in CMVR cases within six months after HSCT (all < 0.05). Immunoglobulins also showed a slower recovery trend in CMVR cases. The recovery of B lymphocytes and natural killer cells exhibited no significant differences between the two groups.
It is not enough to develop fundus screening strategies by merely relying on the CMV serostatus of recipients. Dynamic and continuous monitoring of T lymphocyte subsets, especially within six months post-HSCT, as well as serum immunoglobulin levels, can provide assistance with screening program of CMVR in HSCT recipients with severe aplastic anemia.
异基因造血干细胞移植（HSCT）后免疫重建延迟与巨细胞病毒（CMV）感染显著相关。本研究旨在观察发生 CMV 视网膜炎（CMVR）的 HSCT 受者外周血淋巴细胞亚群和免疫球蛋白的恢复趋势。
我们从 2015 年至 2020 年在一家中心接受异基因 HSCT 的 404 例连续严重再生障碍性贫血患者的数据库中，进行了这项病例对照研究，确定了 37 例 CMVR 病例和 303 例非 CMVR 对照。我们分析了移植结局和免疫重建原则，重点关注 HSCT 后一年内的淋巴细胞 CD 系列和免疫球蛋白系列。
37 例患者（55 只眼）诊断为 CMVR，平均发病时间为 HSCT 后 155 天。在 37 例患者中，有 1 例患者的血液中从未检测到 CMV，但在 CMVR 诊断时眼内液中 CMV 负荷较高。在对照组中，195 例有 CMV 病毒血症，108 例没有。与对照组相比，CMVR 病例的 CMV 病毒血症持续时间更长，CMV 负荷峰值更高。HSCT 后 6 个月内，CMVR 病例的 T 淋巴细胞亚群（包括 CD3、CD4 和 CD8）明显更低（均<0.05）。免疫球蛋白的恢复也呈较慢的趋势。两组间 B 淋巴细胞和自然杀伤细胞的恢复无显著差异。
仅依靠受者的 CMV 血清状态制定眼底筛查策略是不够的。动态、持续监测 T 淋巴细胞亚群，特别是 HSCT 后 6 个月内，以及血清免疫球蛋白水平，可为严重再生障碍性贫血 HSCT 受者 CMVR 的筛查计划提供帮助。
