人巨细胞病毒血清学和感染对异基因造血干细胞移植后患者预后的影响变化：在来特莫韦预防时代的一项意大利前瞻性多中心调查
The Changing Impact of Human Cytomegalovirus Serology and Infection on Patient Outcome After Allogeneic Hematopoietic Stem Cell Transplantation: An Italian Prospective Multicenter Survey in the Era of Letermovir Prophylaxis.
作者信息
Girmenia Corrado, Chiusolo Patrizia, Marsili Giovanni, Piciocchi Alfonso, Micò Maria Caterina, Greco Raffaella, Porto Gaetana, Galaverna Federica, Bonifazi Francesca, Cutini Ilaria, Malagola Michele, Bramanti Stefania, Busca Alessandro, Carella Angelo Michele, Carotti Alessandra, Iori Anna Paola, Onida Francesco, Bono Roberto, Terruzzi Elisabetta, Vacca Adriana, Rinaldi Amelia, Cavattoni Irene Maria, Picardi Alessandra, Faraci Maura, Lazzarotto Tiziana, Baldanti Fausto, Clerici Pierangelo, Castagna Luca, Martino Massimo, Ciceri Fabio
机构信息
Dipartimento di Ematologia, Oncologia, e Dermatologia, Azienda Ospedaliera Universitaria Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.
出版信息
Open Forum Infect Dis. 2025 Apr 18;12(5):ofaf233. doi: 10.1093/ofid/ofaf233. eCollection 2025 May.
BACKGROUND
In the letermovir primary prophylaxis (LET-PP) era, the epidemiology of human cytomegalovirus infection (HCMV-i) in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients has changed.
METHODS
We prospectively evaluated incidence and risk factors for clinically significant (CS) HCMV-i at 180 days from transplant and 1-year overall survival in 1310 allo-HSCTs performed from January 2021 to March 2022 according to LET-PP use.
RESULTS
The cumulative incidence of CS-HCMV-i at 100 and 180 days from transplant was 3.8% and 16%, respectively, in patients who received LET-PP, and 14% and 17% in patients who did not. Variables associated with increased risk of CS-HCMV-i in patients who received LET-PP included transplant from an HCMV-seronegative donor, transplant from a donor other than matched related, >20 days to engraftment, and acute graft-versus-host disease (GVHD). Transplant in HCMV-seropositive recipients was associated with increased risk of CS-HCMV-i in patients who did not receive LET-PP. One-year overall survival after transplant was 81.1%. Acute leukemia, disease not in remission at transplant, Eastern Cooperative Oncology Group performance status >1, >20 days to engraftment, acute GVHD, CS Epstein-Barr virus DNAemia, gram-negative bacteremia, and invasive fungal disease were associated with increased mortality in patients who received LET-PP. HCMV recipient seropositivity, Hematopoietic Cell Transplantation Comorbidity Index score ≥3, and gram-negative bacteremia were associated with increased mortality in patients who did not receive LET-PP.
CONCLUSIONS
In patients who received LET-PP, recipient/donor serology no longer correlates with early CS-HCMV-i whereas it still predicts late CS-HCMV-i as well as risk of CS-HCMV-i in patients who did not receive LET-PP. Donor serology, CS-HCMV-i and HCMV disease no longer impact survival in allo-HSCT recipients who receive LET-PP. . NCT04412811.
背景
在来特莫韦初级预防（LET-PP）时代，异基因造血干细胞移植（allo-HSCT）受者中人类巨细胞病毒感染（HCMV-i）的流行病学已发生变化。
方法
我们根据LET-PP的使用情况，对2021年1月至2022年3月进行的1310例allo-HSCT受者在移植后180天发生临床显著（CS）HCMV-i的发生率和危险因素以及1年总生存率进行了前瞻性评估。
结果
接受LET-PP的患者在移植后100天和180天CS-HCMV-i的累积发生率分别为3.8%和16%，未接受LET-PP的患者分别为14%和17%。接受LET-PP的患者中与CS-HCMV-i风险增加相关的变量包括来自HCMV血清学阴性供者的移植、来自非匹配相关供者的移植、移植后>20天植入以及急性移植物抗宿主病（GVHD）。在未接受LET-PP的患者中，HCMV血清学阳性受者的移植与CS-HCMV-i风险增加相关。移植后1年总生存率为81.1%。急性白血病、移植时疾病未缓解、东部肿瘤协作组体能状态>1、移植后>20天植入、急性GVHD、CS Epstein-Barr病毒血症、革兰阴性菌血症和侵袭性真菌病与接受LET-PP的患者死亡率增加相关。HCMV受者血清学阳性、造血细胞移植合并症指数评分≥3和革兰阴性菌血症与未接受LET-PP的患者死亡率增加相关。
结论
在接受LET-PP的患者中，受者/供者血清学不再与早期CS-HCMV-i相关，而在未接受LET-PP的患者中，它仍可预测晚期CS-HCMV-i以及CS-HCMV-i风险。供者血清学、CS-HCMV-i和HCMV疾病不再影响接受LET-PP的allo-HSCT受者的生存。. NCT04412811。
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