High incidence of cytomegalovirus infection after nonmyeloablative stem cell transplantation: potential role of Campath-1H in delaying immune reconstitution
High incidence of cytomegalovirus infection after nonmyeloablative stem cell transplantation: potential role of Campath-1H in delaying immune reconstitution
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DOI：
10.1182/blood.v99.12.4357
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发表时间：
2002-06-15
期刊：
影响因子：
20.3
通讯作者：
Milligan, DW
中科院分区：
文献类型：
--
作者：
Chakrabarti, S;Mackinnon, S;Milligan, DW
非清髓调节越来越多地用于各种疾病的移植，但对其对感染发生率和免疫重建的影响知之甚少。我们研究了基于聚合酶链反应的检测方法监测巨细胞病毒（CMV）感染的模式和结果，并对101例患者进行了含有campaign - 1h的非清髓性治疗。51例患者（50%）在移植后中位27天发生巨细胞病毒感染，有巨细胞病毒感染风险的患者发生巨细胞病毒感染的概率为84.8%。100天前和100天后CMV感染的复发率分别为53.6%和46.6%，在非亲属供体移植受者中更为常见。所有3例发生巨细胞病毒疾病的患者都死于这一并发症。2例晚期巨细胞病毒疾病患者的GVHD（移植物抗宿主病）等级为111级至IV级，仅4%的患者发生新发，另有10%的患者在供体淋巴细胞输注后发生。在研究的48例患者中，CD4(+) t细胞计数超过200/muL的中位时间为9个月。18个月的总生存率和非复发死亡率概率分别为65%和27.8%，cmv感染和未感染患者的生存率无显著差异。campaign - 1h的使用似乎与GVHD的低发病率有关，但CMV感染的高发病率和免疫麻痹的延长有关。（Blood. 2002;99:4357-4363） (C) 2002年由美国血液学会出版。
Nonmyeloablative conditioning is increasingly used for transplantation in a wide range of diseases, but little is known about its impact on the incidence of infections and immune reconstitution. We examined the pattern and outcome of cytomegalovirus (CMV) infections monitored by polymerase chain reaction-based assays and treated preemptively in 101 patients following nonmyeloablative conditioning containing in vivo Campath-1H. Fifty-one patients (50%) had a CMV infection at a median of 27 days after transplantation with a probability of 84.8% in patients at risk of CMV infection. The probability of recurrence of CMV infection before and after 100 days was 53.6% and 46.6%, respectively, and was more common in unrelated donor transplant recipients. All 3 patients who developed CMV disease died of this complication. The 2 patients with late CMV disease had grade 111] to IV graft-versus-host-disease (GVHD), which occurred de novo in only 4% of patients and in another 10% following donor lymphocyte infusions. The median time to CD4(+) T-cell count more than 200/muL was 9 months in the 48 patients studied. The probabilities of overall survival and nonrelapse mortality at 18 months were 65% and 27.8%, respectively, with no significant difference in survival between CMV-Infected and-uninfected patients. The use of Campath-1H appeared to be associated with a low incidence of GVHD but a high incidence of CMV infections and prolonged immune paresis. (Blood. 2002;99:4357-4363) (C) 2002 by The American Society of Hematology.