Nakano Nobuaki, Nakasone Hideki, Fuji Shigeo, Shinohara Akihito, Suzuki Ritsuro, Utsunomiya Atae, Eto Tetsuya, Morishima Satoko, Ikegame Kazuhiro, Kakinoki Yasutaka, Matsuoka Ken-Ichi, Mori Yasuo, Suehiro Youko, Uchida Naoyuki, Ito Ayumu, Doki Noriko, Ozawa Yukiyasu, Kanda Junya, Kanda Yoshinobu, Fukuda Takahiro, Atsuta Yoshiko, Ogata Masao
Department of Hematology, Imamura General Hospital, Kagoshima, Japan.
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Lancet Reg Health West Pac. 2023 Sep 25;40:100902. doi: 10.1016/j.lanwpc.2023.100902. eCollection 2023 Nov.
Human T-cell leukemia virus type I (HTLV-1) is a retrovirus known to cause adult T-cell leukemia/lymphoma (ATL). There are few reports on hematopoietic stem cell transplantation (HSCT) for HTLV-1 carriers with diseases other than ATL.
A total of 25,839 patients (24,399 adults and 1440 children) with pre-transplant HTLV-1 serostatus information recorded in the Japanese National Survey Database who had undergone their first HSCT were analyzed. We investigated the overall survival (OS), transplant-related mortality (TRM), and disease-related mortality (DRM) after HSCT in relation to HTLV-1 serologic status.
Three hundred and forty-eight patients were HTLV-1 antibody carriers. The number of HTLV-1 carriers and noncarriers among adult patients who received allogeneic HSCT (allo-HSCT) or autologous HSCT (auto-HSCT) was 237/15,777 and 95/8920, respectively, and was 16/1424 among pediatric patients who received allo-HSCT. No pediatric HTLV-1 carrier recipients undergoing auto-HSCT were identified. There were no significant differences between HTLV-1 carriers and non-carriers regarding stem cell source, disease risk, or HCT-CI score prior to allo-HSCT. Multivariate analysis of OS (P = 0.020) and TRM (P = 0.017) in adult patients showed that HTLV-1 positive status was a significant prognostic factor. In children, TRM was significantly higher (P = 0.019), but OS was not significantly different. In adult patients who underwent auto-HSCT, HTLV-1 positive status was not a significant prognostic factor. In adult allo-HSCT patients, cytomegalovirus reactivation was significantly more common in HTLV-1 carriers (P = 0.001).
HTLV-1 antibody positivity was shown to have a poor prognosis in OS and TRM after allo-HSCT in adult patients and in TRM after allo-HSCT in pediatric patients.
This work was supported in part by the practical research programs of the Japan Agency for Medical Research and Development (AMED) under grant number 17ck0106342h0001.
人类嗜T淋巴细胞病毒I型（HTLV-1）是一种已知可导致成人T细胞白血病/淋巴瘤（ATL）的逆转录病毒。关于HTLV-1携带者除ATL之外的疾病进行造血干细胞移植（HSCT）的报道较少。
对日本国家调查数据库中记录了移植前HTLV-1血清学状态且接受首次HSCT的总共25839例患者（24399例成人和1440例儿童）进行分析。我们研究了HSCT后与HTLV-1血清学状态相关的总生存期（OS）、移植相关死亡率（TRM）和疾病相关死亡率（DRM）。
348例患者为HTLV-1抗体携带者。接受异基因HSCT（allo-HSCT）或自体HSCT（auto-HSCT）的成年患者中，HTLV-1携带者和非携带者的数量分别为237/15777和95/8920，接受allo-HSCT的儿科患者中有16/1424例。未发现接受auto-HSCT的儿科HTLV-1携带者受者。在allo-HSCT之前，HTLV-1携带者和非携带者在干细胞来源、疾病风险或HCT-CI评分方面无显著差异。对成年患者的OS（P = 0.020）和TRM（P = 0.017）进行多因素分析显示，HTLV-1阳性状态是一个显著的预后因素。在儿童中，TRM显著更高（P = 0.019），但OS无显著差异。在接受auto-HSCT的成年患者中，HTLV-1阳性状态不是一个显著的预后因素。在成年allo-HSCT患者中，巨细胞病毒再激活在HTLV-1携带者中显著更常见（P = 0.001）。
HTLV-1抗体阳性在成年患者allo-HSCT后的OS和TRM以及儿科患者allo-HSCT后的TRM方面显示出预后不良。
本研究部分得到了日本医疗研究与开发机构（AMED）的实际研究项目支持，资助编号为17ck0106342h0001。
