恶性血液病患者单倍外周血干细胞移植后Epstein-Barr病毒再激活:免疫重建及其对生存的影响

IF 3.4 3区 医学 Q2 HEMATOLOGY
Therapeutic Advances in Hematology Pub Date : 2025-05-06 eCollection Date: 2025-01-01 DOI:10.1177/20406207251335477
Ling Ma, Ying Zhang, Ting Wang, Yu Cai, Jun Yang, Yin Tong, Chongmei Huang, Huiying Qiu, Kun Zhou, Xiaowei Xu, Jiahua Niu, Chang Shen, Xinxin Xia, Yu Wei, Jie Shao, Min Yang, Jingjing Cao, Xianmin Song, Liping Wan
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引用次数: 0

摘要

背景:单倍体造血干细胞移植(haploo - hsct)是恶性血液病患者常用的替代方法。eb病毒(EBV)再激活是移植后常见的并发症,但其对免疫重建和生存的影响尚不清楚。目的:比较单倍体移植后EBV再激活与非EBV再激活患者的免疫重建和生存率。设计:回顾性研究纳入了322例年龄在18-60岁,诊断为血液系统恶性肿瘤的患者,这些患者于2018年1月至2021年12月在我中心接受了单倍造血干细胞移植。方法:采用SPSS (version 24.0)和R4.3.0软件进行数据分析。统计方法:定性变量采用卡方检验,连续变量采用独立t检验,生存分析采用Kaplan-Meier法,危险因素分析采用logistic回归。结果:移植后中位58天,176例患者(54.6%)出现EBV再激活,但只有5例患者出现移植后淋巴增生性疾病。logistic多因素分析显示EBV iga阴性供体、巨细胞病毒(CMV)再激活、抗胸腺细胞球蛋白(ATG)预防移植物抗宿主病(GVHD)是EBV再激活的独立危险因素。基于多元回归,建立移植后EBV再激活的危险因素预测模型。基于广义线性混合模型的分析显示,ebv再激活组的CD8+CD45RO+记忆t细胞和CD16+CD56+ NK细胞的重构显著改善。有无EBV再激活患者的总生存期(p = 0.26)、无复发生存期(p = 0.72)、gvhd无复发生存期(p = 0.44)、累积复发发生率(Gray检验p = 0.72)和移植相关死亡率(Gray检验p = 0.066)均无统计学差异。结论:我们的研究显示EBV iga阴性供体、CMV再激活和用ATG预防GVHD是EBV再激活的独立危险因素。移植后EBV再激活对患者预后无显著影响,但其对免疫重建的影响可能是复杂的。基于该研究的预测模型可以引导我们关注EBV再激活高风险患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Epstein-Barr virus reactivation after haplo-peripheral blood stem cell transplantation in patients with hematological malignancies: immune reconstitution and influence on survival.

Background: Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) is a common alternative for patients with hematological malignancies. Epstein-Barr virus (EBV) reactivation is a common complication post-transplantation, but its impact on immune reconstitution and survival remains unclear.

Objective: To compare immune reconstitution and survival between patients with and without EBV reactivation after haplo-HSCT.

Design: A retrospective study was conducted involving 322 patients aged 18-60 years, diagnosed with hematological malignancies, who underwent haplo-HSCT at our center from January 2018 to December 2021.

Methods: Data analysis was performed using SPSS (version 24.0) and R4.3.0 software. Statistical methods included Chi-square tests for qualitative variables, independent t tests for continuous variables, Kaplan-Meier method for survival analysis, and logistic regression for risk factor analysis.

Results: After a median of 58 days posttransplant, 176 patients (54.6%) had EBV reactivation, but only 5 patients developed posttransplant lymphoproliferative disorder. Logistics multivariate analysis showed EBV IgA-negative donor, cytomegalovirus (CMV) reactivation, and graft-versus-host disease (GVHD) prophylaxis with anti-thymocyte globulin (ATG) were independent risk factors of EBV reactivation. Then a risk factor prediction model for EBV reactivation after transplantation was established based on the multivariate regression. The analysis based on the generalized linear mixed model showed dramatic improvements in the reconstitution of CD8+CD45RO+ memory T-cells and CD16+CD56+ NK cells of the EBV-reactivated group. There was no statistical difference in overall survival (p = 0.26), relapse-free survival (p = 0.72), GVHD-relapse free survival (p = 0.44), cumulative incidence of relapse (Gray's test p = 0.72), and transplant-related mortality (Gray's test p = 0.066) between patients with and without EBV reactivation.

Conclusion: Our study showed EBV IgA-negative donor, CMV reactivation, and GVHD prophylaxis with ATG were independent risk factors of EBV reactivation. Posttransplant EBV reactivation had no significant influence on the outcomes of patients, but its impact on immune reconstitution might be complicated. The predictive model based on the study could direct our attention toward patients at high risk of EBV reactivation.

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来源期刊
CiteScore
4.30
自引率
0.00%
发文量
54
审稿时长
7 weeks
期刊介绍: Therapeutic Advances in Hematology delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of hematology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in hematology, providing a forum in print and online for publishing the highest quality articles in this area.
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