Epstein-Barr virus reactivation after allogeneic hematopoietic stem cell transplantation: multifactorial impact on transplant outcomes
Epstein-Barr virus reactivation after allogeneic hematopoietic stem cell transplantation: multifactorial impact on transplant outcomes
复制标题
异基因造血干细胞移植后 Epstein-Barr 病毒再激活：对移植结果的多因素影响
DOI：
10.1038/s41409-020-0831-7
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发表时间：
2020-02-17
影响因子：
4.8
通讯作者：
Wu, Depei
中科院分区：
文献类型：
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作者：
Ru, Yuhua;Zhang, Xiang;Wu, Depei
同种异体造血细胞移植（alloo - hct）后eb病毒（EBV）的再激活是可能导致致命性EBV疾病的主要问题之一。然而，由于HCT方案和供体选择的显著发展，需要更新数据。我们进行了一项回顾性研究，纳入了890名同种异体hct接受者。EBV再激活的独立危险因素是使用抗胸腺细胞球蛋白、单倍体相同的供体和存在慢性移植物抗宿主病。有0、1、2、3个危险因素的患者EBV再激活的累积发生率分别为2.9%、11.7%、27.3%、41.9% （P < 0.001）。7例患者发生移植后淋巴细胞增生性疾病（PTLDs）。在hct后存活超过2年的受体中，EBV再激活与较差的生存率相关（P < 0.001），但可能通过降低复发发生率而使恶性肿瘤患者受益（P = 0.046）。首次或第二次缓解的患者在HCT后1年的复发率下降（P = 0.042），晚期疾病患者在HCT后1年的复发率下降（P = 0.032）。我们的结论是，在目前的管理下，PTLDs得到了有效的控制，但EBV再激活仍然对移植结果有多因素影响。需要多中心前瞻性研究来验证这些发现。
Epstein-Barr virus (EBV) reactivation after allogeneic hematopoietic cell transplantation (allo-HCT) is one of the major concerns that may lead to fatal EBV diseases. However, updated data are needed because of the remarkable evolution of the HCT protocol and donor selection. We conducted a retrospective study that enrolled 890 allo-HCT recipients. Independent risk factors for EBV reactivation were use of antithymocyte globulin, haploidentical donor, and the presence of chronic graft-versus-host disease. The cumulative incidence of EBV reactivation was 2.9%, 11.7%, 27.3%, and 41.9% for patients with 0, 1, 2, and 3 risk factors, respectively (P < 0.001). Posttransplant lymphoproliferative disorders (PTLDs) occurred in seven patients. EBV reactivation was associated with inferior survival in recipients who survived more than 2 years post-HCT (P < 0.001) but might time-dependently benefit those patients with malignancies by decreasing relapse incidence (P = 0.046). A decreased relapse incidence was observed 1 year after HCT for recipients at first or second remission (P = 0.042) and in the first year post-HCT for recipients with advanced diseases (P = 0.032). We concluded that with current management, PTLDs were efficiently controlled, but EBV reactivation still had a multifactorial impact on transplant outcomes. Multicenter prospective studies are warranted to validate these findings.