CMV infection combined with acute GVHD associated with poor CD8+T-cell immune reconstitution and poor prognosis post-HLA-matched allo-HSCT
CMV infection combined with acute GVHD associated with poor CD8+T-cell immune reconstitution and poor prognosis post-HLA-matched allo-HSCT
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CMV 感染合并急性 GVHD 与 CD8 T 细胞免疫重建不良和 HLA 匹配异基因 HSCT 后预后不良相关
DOI：
10.1093/cei/uxac047
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发表时间：
2022-05-12
影响因子：
4.6
通讯作者：
Zhao, Xiang-Yu
中科院分区：
文献类型：
--
作者：
Fan, Ze-Ying;Han, Ting-Ting;Zhao, Xiang-Yu
巨细胞病毒（CMV）感染和急性移植物抗宿主病（aGVHD）是造血干细胞移植（HSCT）后导致预后不良的两种主要并发症。优越的上级早期免疫重建（IR）与HSCT后生存率的改善相关。然而，当所有三个因素，CMV感染，aGVHD和IR，同时考虑，HSCT的三重事件的影响仍然是未知的，应该进一步研究。因此，我们在2010年1月至2014年12月期间招募了185名被诊断为血液恶性肿瘤并接受HLA匹配的同胞移植（MST）治疗的患者，其中83名CMV感染阳性，82名患有aGVHD。结果显示，合并aGVHD和CMV感染的患者无复发死亡率（NRM）显著升高，总生存率（OS）显著降低，CD8+ T细胞免疫反应延迟。多因素分析显示，合并aGVHD和CMV感染以及CD8+ T细胞免疫反应延迟是影响MST术后患者预后的独立危险因素。复发性CMV感染与CD8+ T细胞重建不良相关。但上级IR可预防aGVHD和CMV感染对移植结局的负面影响，aGVHD和CMV感染的同时发生显著影响HLA相合同胞造血干细胞移植的结局。然而，上级免疫重建（IR）可以防止aGVHD和CMV感染（双阳性，DP）对移植结果的负面影响。
Cytomegalovirus (CMV) infection and acute graft-versus-host disease (aGVHD) are two major complications that contribute to a poor prognosis after hematopoietic stem cell transplantation (HSCT). Superior early immune reconstitution (IR) is associated with improved survival after HSCT. However, when all three factors, CMV infection, aGVHD, and IR, are concomitantly considered, the effects of the triple events on HSCT are still unknown and should be studied further. Thus we enrolled 185 patients who were diagnosed as hematological malignancies and treated with HLA-matched sibling transplantation (MST) between January 2010 and December 2014, of whom 83 were positive for CMV infection and 82 had aGVHD. Results showed that patients with both aGVHD and CMV infection had significantly higher non-relapse mortality (NRM), lower overall survival (OS), and delayed CD8+ T-cell IR. Multivariate analyses showed that both aGVHD combined with CMV infection and delayed CD8+ T-cell IR were independent risk factors for prognosis post-MST. Recurrent CMV infections are associated with poor CD8+ T-cell reconstitution. However, superior IR could protect against the negative effects of aGVHD and CMV infection on the transplant outcomes.Co-occurrence of aGVHD and CMV infection significantly affect the outcomes of HLA-matched sibling hematopoietic stem cell transplantation. However, superior immune reconstitution (IR) could protect against the negative effects of aGVHD and CMV infection (double positive, DP) on the transplant outcomes.