Analysis of late infections in 89 long-term survivors of bone marrow transplantation.
Analysis of late infections in 89 long-term survivors of bone marrow transplantation.
复制标题
89例骨髓移植长期存活者晚期感染分析
作者：
K. Atkinson;R. Storb;R. Prentice;Weiden Pl;R. Witherspoon;K. Sullivan;D. Noel;Thomas Ed
对89例存活6个月以上的再生障碍性贫血或急性白血病患者进行了同基因（13例）或异基因（76例）骨髓移植，以确定晚期感染的发生率。大多数患者（72%）要么没有感染，要么很少有晚期感染，只有少数人（28%）有三次或三次以上感染。8例患者（9%）死于感染。肺部、呼吸道、皮肤细菌感染。而血液感染在152例感染中占了一半以上。革兰氏阳性球菌占记录的感染微生物的三分之一。22%的患者出现带状疱疹（VZ）感染。每个受影响的患者只有一次VZ感染。真菌感染和间质性肺炎不常见。通过使用比例风险回归模型，我们试图确定预测和诱发晚期感染的临床和免疫因素。只有一个因素与晚期非VZ感染显著相关：慢性移植物抗宿主病（C-GVHD）。分析的其他因素，例如。基础疾病。预处理方案移植类型对皮肤二硝基氯苯（DNCB）无反应。年龄和性别。并没有显示出明显的关联。相反。VZ感染与C-GVHD无关。DNCB皮肤试验阴性反应似乎是与VZ感染相关的唯一因素。同基因和异基因骨髓移植后，在少数长期存活者中观察到的复发性（偶尔致命）感染最有可能是体液和细胞免疫缺陷的结果。而这又最常与C-GVHD相关。越来越多的来自HLA相同的兄弟姐妹（异基因移植物）和单卵双胞胎（同基因移植物）的骨髓移植正在被用于治疗再生障碍性贫血（AA）和急性白血病（AL）。7在准备移植时，患者自身的造血和免疫系统被高剂量环磷酰胺（CY）和/或全身照射（TBI）治疗破坏。随后造血和免疫功能的恢复依赖于供体骨髓来源的细胞的增殖。移植后2-4周粒细胞计数较低。这一时期的特点是频繁的细菌和真菌感染。78免疫功能在前4个月最严重。912在这一时期，间质性肺炎，可能与免疫缺陷状态有关，是主要的
Eighty-nine patients with aplastic anemia or acute leukemia treated by either syngeneic (1 3 patients) or allogeneic (76 patients) marrow transplantation who had survived for more than 6 mo were surveyed to determine the incidence of late infections. Most patients (72 % ) had either no infection or very few late infections, and only a minority (28 % ) had three or more infections. Eight patients (9 % ) died from infection. Bacterial infections of lung, respiratory tract, skin. and blood represented more than half of the 1 52 infections encountered. Gram-positive cocci represented one-third of the documented infecting organisms. Varicella-zoster (VZ) infections were seen in 22 % of all patients. Each affected patient had only a single episode of VZ infection. Fungal infections and interstitial pneumonia were uncommon. By the use of a proportional hazards regression model we attempted to identify clinical and immunologic factors predictive of and predisposing to late infections. Only one factor was significantly associated with late non-VZ infectons: chronic graftversus-host disease (C-GVHD). Other factons analyzed, e.g.. underlying disease. conditioning regimen, type of transplant. inability to respond to cutaneous dinitrochlorobenzene (DNCB). age, and sex. did not show significant associations. In contrast. VZ infections were not associated with C-GVHD. Negative DNCB skin test reactivity appeared to be the only factor correlating with VZ infections. The recurrent (and occasionally fatal) infections seen in a minority of long-term survivors after syngeneic and allogeneic marrow transplantation are most likely the result of deficits of humoral and cellular immunity. which in turn are most often associated with C-GVHD. I NCREASING NUMBERS of bone marrow transplants from HLA-identical siblings (allogeneic grafts) and monozygous twins (syngeneic grafts) are being carried out for the treatment of aplastic anemia (AA) and acute leukemia (AL).’7 In preparation for the transplant the patients’ own hemopoietic and immunologic systems are destroyed by therapy with high-dosage cyclophosphamide (CY) and/or total body irradiation (TBI). Subsequent recovery of hemopoiesis and immune function is dependent on proliferation of cells of donor marrow origin. Granulocyte counts are low during the first 2-4 wk after transplantation. This period is characterized by frequent bacterial and fungal infections.78 Immunologic function is most severely depressed during the first 4 mo.912 In this period interstitial pneumonias, presumably related to the state of immunodeficiency, are a major
DOI：
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发表时间：
1972
期刊：
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影响因子：
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作者：
D. Cox
通讯作者：
D. Cox