Recovery of CMV immunity after allogeneic haematopoietic stem cell transplant — Insight from an in-depth analysis of a small cohort of patients with clinical correlation

IF 1.6 4区医学 Q4 IMMUNOLOGY

Transplant immunology Pub Date : 2026-02-01 Epub Date: 2026-01-09 DOI:10.1016/j.trim.2026.102344

Yeh-ching Linn, Kirubavathy Sundar Raj

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Abstract

Background

We conducted an evaluation of the IFN-g ELISpot assay with the primary objective of exploring its clinical use after allogeneic haematopoietic stem cell transplant (allo-HSCT). Here we analysed its correlation with occurrence of clinically-significant CMV infection (cs-CMVi) and risk factors.

Method

Frozen mononuclear cells collected at 2, 3, 4 and 5 months after allo-HSCT were tested against CMV pooled peptide pp65 and IE1 in an IFN-g ELISpot assay. Spot forming cells (SFC) per 250,000 cells were correlated with clinical course.

Results

Amongst the 18 CMV seropositive recipients including 3 with seronegative donors, 11 of the 14 low responders (< 50 SFC) developed cs-CMVi while all the 4 high responders with >50 SFC were protected. High dose glucocorticoids (1 mg/kg or higher) predisposed to a second episode of cs-CMVi even after acquisition of more than 50 SFC after the first episode, while low dose (20 mg/day or lower) did not matter. Low level CMV viremia resolved spontaneously in 2 of the 4 high responders but progressed to cs-CMVi in the other 11 low responders. Consistent with literature, recipients of T-depleting regimen and cord blood were at a higher risk of cs-CMVi. The median time to first acquisition of more than 50 SFC was 118 days. The 3 recipients of seronegative donors did not recover immunity beyond the monitoring period and 2 had recurrent cs-CMVi.

Conclusion

This small series provides in-depth insight into the recovery of CMV immunity and cs-CMVi post allo-HSCT for each recipient and supplements knowledge provided by large series.

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同种异体造血干细胞移植后巨细胞病毒免疫的恢复——对具有临床相关性的小队列患者的深入分析

背景：我们对IFN-g ELISpot检测进行了评估，主要目的是探索其在同种异体造血干细胞移植（alloo - hsct）后的临床应用。在这里，我们分析了其与临床显著巨细胞病毒感染（cs-CMVi）的发生和危险因素的相关性。方法：采用IFN-g ELISpot法检测同种异体造血干细胞移植后2、3、4和5 个月收集的冷冻单核细胞对CMV合并肽pp65和IE1的抑制作用。每25万个细胞中斑点形成细胞（SFC）与临床病程相关。结果：18例CMV血清阳性受者（3例血清阴性供者）中，14例低应答者（< 50 SFC）中有11例发展为cs-CMVi，而4例高应答者（< 50 SFC）均得到保护。高剂量糖皮质激素（1 mg/kg或更高）即使在首次发作后获得超过50 SFC后也易导致cs-CMVi第二次发作，而低剂量（20 mg/天或更低）则无关紧要。在4例高应答者中，2例低水平CMV病毒血症自发消退，但在其他11例低应答者中进展为cs-CMVi。与文献一致，接受t消耗方案和脐带血的患者cs-CMVi的风险更高。首次收购超过50家SFC的中位数时间为118 天。3例血清阴性供体受者在监测期后未恢复免疫力，2例复发。结论：这个小系列深入了解了每个受体在同种异体造血干细胞移植后CMV免疫和cs-CMVi的恢复情况，并补充了大系列提供的知识。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant immunology 医学-免疫学

CiteScore

2.10

自引率

13.30%

发文量

198

审稿时长

48 days

期刊介绍： Transplant Immunology will publish up-to-date information on all aspects of the broad field it encompasses. The journal will be directed at (basic) scientists, tissue typers, transplant physicians and surgeons, and research and data on all immunological aspects of organ-, tissue- and (haematopoietic) stem cell transplantation are of potential interest to the readers of Transplant Immunology. Original papers, Review articles and Hypotheses will be considered for publication and submitted manuscripts will be rapidly peer-reviewed and published. They will be judged on the basis of scientific merit, originality, timeliness and quality.