Stanojevic Maja, Bertaina Alice, Bonfim Carmem, Ciccocioppo Rachele, Cohen Sandra, Purtill Duncan, Ruggeri Annalisa, Russell Athena, Sharma Akshay, Wynn Robert, Boelens Jaap Jan, Prockop Susan, Abraham Allistair
Department of Pediatrics, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, California, USA.
Cytotherapy. 2022 Sep;24(9):884-891. doi: 10.1016/j.jcyt.2022.05.010. Epub 2022 Jun 12.
Despite recent advances in the field of HSCT, viral infections remain a frequent causeof morbidity and mortality among HSCT recipients. Adoptive transfer of viral specific T cells has been successfully used both as prophylaxis and treatment of viral infections in immunocompromised HSCT recipients. Increasingly, precise risk stratification of HSCT recipients with infectious complications should incorporate not only pretransplant clinical criteria, but milestones of immune reconstitution as well. These factors can better identify those at highest risk of morbidity and mortality and identify a population of HSCT recipients in whom adoptive therapy with viral specific T cells should be considered for either prophylaxis or second line treatment early after inadequate response to first line antiviral therapy. Broadening these approaches to improve outcomes for transplant recipients in countries with limited resources is a major challenge. While the principles of risk stratification can be applied, early detection of viral reactivation as well as treatment is challenging in regions where commercial PCR assays and antiviral agents are not readily available.
尽管造血干细胞移植（HSCT）领域最近取得了进展，但病毒感染仍然是HSCT受者发病和死亡的常见原因。病毒特异性T细胞的过继转移已成功用于免疫功能低下的HSCT受者病毒感染的预防和治疗。越来越多的是，对有感染并发症的HSCT受者进行精确的风险分层不仅应纳入移植前的临床标准，还应纳入免疫重建的里程碑。这些因素可以更好地识别那些发病和死亡风险最高的人，并确定一类HSCT受者，对于他们，在对一线抗病毒治疗反应不足后早期，应考虑采用病毒特异性T细胞过继治疗进行预防或二线治疗。在资源有限的国家扩大这些方法以改善移植受者的结局是一项重大挑战。虽然可以应用风险分层原则，但在商业PCR检测和抗病毒药物不易获得的地区，早期检测病毒再激活以及治疗具有挑战性。
