Impact of cytomegalovirus (CMV) reactivation after umbilical cord blood transplantation.
Impact of cytomegalovirus (CMV) reactivation after umbilical cord blood transplantation.
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DOI：
10.1016/j.bbmt.2009.09.019
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发表时间：
2010-02
影响因子：
4.3
通讯作者：
Verneris, Michael R.
中科院分区：
文献类型：
--
作者：
Beck, Jill C.;Wagner, John E.;DeFor, Todd E.;Brunstein, Claudio G.;Schleiss, Mark R.;Young, Jo-Anne;Weisdorf, Daniel H.;Cooley, Sarah;Miller, Jeffrey S.;Verneris, Michael R.
本研究探讨了移植前巨细胞病毒血清状态和移植后巨细胞病毒再激活和疾病对脐带血移植（UCBT）结果的影响。1994年至2007年间，332例恶性血液病患者接受了UCBT， 54%的患者CMV血清阳性。移植前受体CMV血清状态对急性或慢性GVHD、复发、DFS或OS没有影响。CMV血清阳性受体的第100天TRM有增大的趋势（p=0.07）。51%（92/180）的患者发生巨细胞病毒再激活，清骨髓与RIC受体无差异（p=0.33）。同样，再激活不受移植UCB单位数量、HLA差异程度、CD34+或CD3+细胞剂量或供体KIR基因单倍型的影响。淋巴细胞快速恢复与CMV再激活相关（p=0.02）。CMV再激活与急性（p=0.97）或慢性GVHD （p=0.65）无关，也不影响TRM （p=0.88）、复发（p=0.62）或生存（p=0.78）。13.8%的CMV血清阳性患者发生CMV疾病，导致TRM升高（p=0.01）， OS降低（p=0.02）。因此，虽然受体CMV血清状态和CMV再激活对UCB移植结果的影响不大，但CMV疾病的发展仍然是一种风险，与较差的结果相关。
This study investigated the impact of pre-transplant CMV serostatus and post-transplant CMV reactivation and disease on umbilical cord blood transplant (UCBT) outcomes. Between 1994 and 2007, 332 patients with hematologic malignancies underwent UCBT and 54% were CMV seropositive. Pre-transplant recipient CMV serostatus had no impact on acute or chronic GVHD, relapse, DFS or OS. There was a trend toward greater day 100 TRM in CMV seropositive recipients (p=0.07). CMV reactivation occurred in 51% (92/180) of patients with no difference in myeloablative vs. RIC recipients (p=0.33). Similarly, reactivation was not influenced by the number of UCB units transplanted, the degree of HLA disparity, the CD34+ or CD3+ cell dose or donor KIR gene haplotype. Rapid lymphocyte recovery was associated with CMV reactivation (p=0.02). CMV reactivation was not associated with acute (p=0.97) or chronic GVHD (p=0.65), nor did it impact TRM (p=0.88), relapse (p=0.62) or survival (p=0.78). CMV disease occurred in 13.8% of the CMV seropositive patients resulting in higher TRM (p=0.01) and lower OS (p=0.02). Thus, while recipient CMV serostatus and CMV reactivation have little demonstrable impact on UCB transplant outcomes, the development of CMV disease remains a risk, associated with inferior outcomes.
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