Merchán-Muñoz Beatriz, Suárez-Lledó María, Rodríguez-Lobato Luis Gerardo, Aiello Tommaso Francesco, Gallardo-Pizarro Antonio, Charry Paola, Cid Joan, Lozano Miquel, Pedraza Alexandra, Martínez-Roca Alexandra, Guardia Ares, Guardia Laia, Moreno Cristina, Carreras Enric, Rosiñol Laura, García-Vidal Carolina, Fernández-Avilés Francesc, Martínez Carmen, Rovira Montserrat, Salas María Queralt
Hematopoietic Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases (ICAMS), Hospital Clínic Barcelona, 08036 Barcelona, Spain.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain.
Cancers (Basel). 2025 Mar 26;17(7):1109. doi: 10.3390/cancers17071109.
This study evaluated infectious complications and immune reconstitution in 253 adults undergoing peripheral blood allogeneic hematopoietic cell transplantation (allo-HCT) with post-transplant cyclophosphamide (PTCY)-based GVHD prophylaxis. Patients received grafts from HLA-matched donors (47.4%), mismatched unrelated donors (MMUD, 33.2%), or haploidentical donors (19.4%). The estimated 2-year non-relapse mortality (NRM) was 11.8%, 26.4%, and 22.4%, respectively ( = 0.0528). The cumulative incidence (Cum.Inc) of acute and chronic GVHD, immunosuppression duration, and post-transplant outcomes were similar across donor types. The day +30 Cum.Inc of bacterial bloodstream infections (BSI) tended to be higher in HLA-matched transplants (49.2%, = 0.073), while HHV-6 reactivation showed a trend toward higher frequency in haploidentical transplants (22.4%, = 0.068). Cytomegalovirus (CMV) reactivation occurred between days +30 and +100, with the highest Cum.Inc in MMUD (59.5%, = 0.033). BK virus-associated hemorrhagic cystitis showed a trend toward higher incidence in MMUD (22.3%, = 0.056). Respiratory and fungal infections were most frequent in the first 100 days, with comparable rates across donor types. By day +180, most patients achieved immune reconstitution, with normalization of CD4+ T cells, CD8+ T cells, and IgG levels, independent of donor type. Patients undergoing allo-HCT with PTCY-based prophylaxis experience a high infectious density rate early post-transplant, which decreases after 6 months as immune reconstitution progresses, regardless of donor type.
本研究评估了253例接受外周血异基因造血细胞移植（allo-HCT）并采用基于移植后环磷酰胺（PTCY）预防移植物抗宿主病（GVHD）的成年患者的感染并发症和免疫重建情况。患者接受来自人类白细胞抗原（HLA）匹配供者（47.4%）、不匹配无关供者（MMUD，33.2%）或单倍体相合供者（19.4%）的移植物。估计2年非复发死亡率（NRM）分别为11.8%、26.4%和22.4%（P = 0.0528）。急性和慢性GVHD的累积发生率（Cum.Inc）、免疫抑制持续时间以及移植后结局在不同供者类型之间相似。HLA匹配移植中细菌血流感染（BSI）的第30天Cum.Inc倾向于更高（49.2%，P = 0.073），而单倍体相合移植中人类疱疹病毒6型（HHV-6）激活频率有更高的趋势（22.4%，P = 0.068）。巨细胞病毒（CMV）激活发生在第30天至第100天之间，MMUD中的Cum.Inc最高（59.5%，P = 0.033）。BK病毒相关出血性膀胱炎在MMUD中有发生率更高的趋势（22.3%，P = 0.056）。呼吸道和真菌感染在最初100天最为常见，不同供者类型的发生率相当。到第180天，大多数患者实现了免疫重建，CD4 + T细胞、CD8 + T细胞和IgG水平恢复正常，与供者类型无关。接受基于PTCY预防的allo-HCT患者在移植后早期感染密度率较高，随着免疫重建进展，6个月后该率下降，与供者类型无关。
