Student Research Committee, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Rev Med Virol. 2024 Jul;34(4):e2558. doi: 10.1002/rmv.2558.
Cytomegalovirus (CMV) infection poses significant risks in allogeneic haematopoietic stem cell transplant (allo-HSCT) recipients. Despite advances in antiviral therapies, issues such as drug resistance, side effects, and inadequate immune reconstitution remain. This systematic review and meta-analysis aim to evaluate the efficacy and safety of adoptive cell therapy (ATC) in managing CMV infections in allo-HSCT recipients. Adhering to preferred reporting items for systematic reviews and meta-analyses guidelines, we conducted a comprehensive database search through July 2023. A systematic review and meta-analysis were conducted on studies involving HSCT patients with CMV infections treated with ATC. The primary outcome was the response rate to ATC, and secondary outcomes included adverse events associated with ATC. The Freeman-Tukey transformation was applied for analysis. In the meta-analysis of 40 studies involving 953 participants, ATC achieved an overall integrated response rate of 90.16%, with a complete response of 82.59% and a partial response of 22.95%. ATC source, HLA matching, steroid intake, and age group markedly influenced response rates. Donor-derived T-cell treatments exhibited a higher response rate (93.66%) compared to third-party sources (88.94%). HLA-matched patients demonstrated a response rate of 92.90%, while mismatched patients had a lower rate. Children showed a response rate of 83.40%, while adults had a notably higher rate of 98.46%. Adverse events were minimal, with graft-versus-host disease occurring in 24.32% of patients. ATC shows promising response rates in treating CMV infections post-HSCT, with an acceptable safety profile. However, to establish its efficacy conclusively and compare it with other antiviral treatments, randomised controlled trials are essential. Further research should prioritise such trials over observational and one-arm studies to provide robust evidence for clinical decision-making.
巨细胞病毒（CMV）感染对异基因造血干细胞移植（allo-HSCT）受者构成重大风险。尽管抗病毒治疗取得了进展，但仍存在耐药性、副作用和免疫重建不足等问题。本系统评价和荟萃分析旨在评估过继细胞治疗（ATC）在管理 allo-HSCT 受者 CMV 感染中的疗效和安全性。我们遵循系统评价和荟萃分析的首选报告项目指南，通过 2023 年 7 月进行了全面的数据库搜索。对涉及接受 ATC 治疗的 CMV 感染 HSCT 患者的研究进行了系统评价和荟萃分析。主要结局是 ATC 的反应率，次要结局包括与 ATC 相关的不良事件。采用 Freeman-Tukey 变换进行分析。在对 40 项涉及 953 名参与者的研究进行的荟萃分析中，ATC 的总体综合反应率为 90.16%，完全反应率为 82.59%，部分反应率为 22.95%。ATC 来源、HLA 匹配、皮质类固醇摄入和年龄组显著影响反应率。与第三方来源（88.94%）相比，供体来源 T 细胞治疗的反应率更高（93.66%）。HLA 匹配患者的反应率为 92.90%，而不匹配患者的反应率较低。儿童的反应率为 83.40%，而成年人的反应率明显更高，为 98.46%。不良事件较少，发生移植物抗宿主病的患者为 24.32%。ATC 在治疗 allo-HSCT 后 CMV 感染方面显示出有希望的反应率，具有可接受的安全性。然而，为了明确其疗效并将其与其他抗病毒治疗方法进行比较，需要进行随机对照试验。进一步的研究应该优先考虑这些试验而不是观察性和单臂研究，为临床决策提供强有力的证据。
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