Kar Yee Yong, Shio Yen Tio, Beatrice Z Sim, Joe Sasadeusz, Alex Rivalland, Lynette Chee, Jeff Szer, Tim Spelman, Monica Slavin, David Ritchie, Michelle K Yong
{"title":"异基因造血细胞移植后多种病毒感染的发生率和临床结果。","authors":"Kar Yee Yong, Shio Yen Tio, Beatrice Z Sim, Joe Sasadeusz, Alex Rivalland, Lynette Chee, Jeff Szer, Tim Spelman, Monica Slavin, David Ritchie, Michelle K Yong","doi":"10.1093/ofid/ofaf597","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Recipients of allogeneic hematopoietic cell transplantation (alloHCT) are at risk of multiple viral infections. However, our knowledge about the clinical impact of viruses following alloHCT is predominantly focused on outcomes of a single viral infection such as cytomegalovirus (CMV). This retrospective cohort study aimed to evaluate the incidence, risk factors, and clinical outcomes of multiple viral infections in the first year following alloHCT.</p><p><strong>Methods: </strong>All microbiologically confirmed viral infection of CMV, Epstein-Barr virus (EBV), BK polyomavirus (BKV), varicella zoster virus, human herpesvirus 6, herpes simplex virus, and various respiratory viruses were reviewed up to 12 months post-alloHCT.</p><p><strong>Results: </strong>Among 430 alloHCT recipients, 744 viral infections were observed within the first year posttransplantation, predominantly CMV (55%), followed by EBV (51%) and BKV (21%). Eighty-five percent of patients had at least 1 viral infection, of which 34% had 2 and 24% had ≥3 viruses. Independent risk factors of multiple viral infections included CMV serostatus (R<sup>+</sup>/D<sup>-</sup>: hazard ratio [HR], 2.59 [95% confidence interval {CI}, 2.03-3.30]; R<sup>-</sup>/D<sup>+</sup>: HR, 2.25 [95% CI, 1.66-3.05]), haploidentical donor (HR, 1.56 [95% CI, 1.18-2.06]), T-cell depletion use (HR, 1.44 [95% CI, 1.11-1.88]), and grade III-IV acute graft-versus-host disease (HR, 1.44 [95% CI, 1.15-1.80]). Patients experiencing multiple viral infections (≥3 vs 2 vs 1) had an earlier time to onset of first infection (median, 18 vs 25 vs 40 days), were hospitalized for an increased number of days (median, 53 vs 40 vs 37 days), and had lower survival probability at day 270 following infusion (<i>P</i> = .044).</p><p><strong>Conclusions: </strong>Multiple viral infections were frequently observed, with a significant impact on morbidity and mortality following alloHCT.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 10","pages":"ofaf597"},"PeriodicalIF":3.8000,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502645/pdf/","citationCount":"0","resultStr":"{\"title\":\"Incidence and Clinical Outcomes of Multiple Viral Infections After Allogeneic Hematopoietic Cell Transplantation.\",\"authors\":\"Kar Yee Yong, Shio Yen Tio, Beatrice Z Sim, Joe Sasadeusz, Alex Rivalland, Lynette Chee, Jeff Szer, Tim Spelman, Monica Slavin, David Ritchie, Michelle K Yong\",\"doi\":\"10.1093/ofid/ofaf597\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Recipients of allogeneic hematopoietic cell transplantation (alloHCT) are at risk of multiple viral infections. However, our knowledge about the clinical impact of viruses following alloHCT is predominantly focused on outcomes of a single viral infection such as cytomegalovirus (CMV). This retrospective cohort study aimed to evaluate the incidence, risk factors, and clinical outcomes of multiple viral infections in the first year following alloHCT.</p><p><strong>Methods: </strong>All microbiologically confirmed viral infection of CMV, Epstein-Barr virus (EBV), BK polyomavirus (BKV), varicella zoster virus, human herpesvirus 6, herpes simplex virus, and various respiratory viruses were reviewed up to 12 months post-alloHCT.</p><p><strong>Results: </strong>Among 430 alloHCT recipients, 744 viral infections were observed within the first year posttransplantation, predominantly CMV (55%), followed by EBV (51%) and BKV (21%). Eighty-five percent of patients had at least 1 viral infection, of which 34% had 2 and 24% had ≥3 viruses. Independent risk factors of multiple viral infections included CMV serostatus (R<sup>+</sup>/D<sup>-</sup>: hazard ratio [HR], 2.59 [95% confidence interval {CI}, 2.03-3.30]; R<sup>-</sup>/D<sup>+</sup>: HR, 2.25 [95% CI, 1.66-3.05]), haploidentical donor (HR, 1.56 [95% CI, 1.18-2.06]), T-cell depletion use (HR, 1.44 [95% CI, 1.11-1.88]), and grade III-IV acute graft-versus-host disease (HR, 1.44 [95% CI, 1.15-1.80]). Patients experiencing multiple viral infections (≥3 vs 2 vs 1) had an earlier time to onset of first infection (median, 18 vs 25 vs 40 days), were hospitalized for an increased number of days (median, 53 vs 40 vs 37 days), and had lower survival probability at day 270 following infusion (<i>P</i> = .044).</p><p><strong>Conclusions: </strong>Multiple viral infections were frequently observed, with a significant impact on morbidity and mortality following alloHCT.</p>\",\"PeriodicalId\":19517,\"journal\":{\"name\":\"Open Forum Infectious Diseases\",\"volume\":\"12 10\",\"pages\":\"ofaf597\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2025-09-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502645/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Open Forum Infectious Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ofid/ofaf597\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/10/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open Forum Infectious Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ofid/ofaf597","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/10/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：同种异体造血细胞移植（allogeneic hematopoietic cell transplantation, alloHCT）的受者存在多种病毒感染的风险。然而，我们对同种异体hct后病毒的临床影响的了解主要集中在单一病毒感染的结果，如巨细胞病毒（CMV）。本回顾性队列研究旨在评估同种异体hct术后第一年多重病毒感染的发生率、危险因素和临床结果。方法：对同种异体hct后12个月内所有经微生物学证实的巨细胞病毒、eb病毒、BK多瘤病毒、水痘带状疱疹病毒、人疱疹病毒6型、单纯疱疹病毒和各种呼吸道病毒感染病例进行回顾性分析。结果：在430例同种异体hct受体中，移植后一年内观察到744例病毒感染，主要是巨细胞病毒（55%），其次是EBV（51%）和BKV（21%）。85%的患者至少有1种病毒感染，其中34%有2种病毒感染，24%有≥3种病毒感染。多重病毒感染的独立危险因素包括CMV血清状态（R+/D-：危险比[HR]， 2.59[95%置信区间{CI}， 2.03-3.30]； R-/D+：危险比[HR]， 2.25 [95% CI, 1.66-3.05]）、单倍体供体（HR, 1.56 [95% CI, 1.18-2.06]）、t细胞耗损使用（HR, 1.44 [95% CI, 1.11-1.88]）和III-IV级急性移植物抗宿主病（HR, 1.44 [95% CI, 1.15-1.80]）。多次病毒感染（≥3 vs 2 vs 1）的患者发生首次感染的时间较早（中位数，18 vs 25 vs 40天），住院天数增加（中位数，53 vs 40 vs 37天），并且在输注后270天生存率较低（P = 0.044）。结论：多次病毒感染是常见的，对同种异体hct后的发病率和死亡率有显著影响。
Incidence and Clinical Outcomes of Multiple Viral Infections After Allogeneic Hematopoietic Cell Transplantation.
Background: Recipients of allogeneic hematopoietic cell transplantation (alloHCT) are at risk of multiple viral infections. However, our knowledge about the clinical impact of viruses following alloHCT is predominantly focused on outcomes of a single viral infection such as cytomegalovirus (CMV). This retrospective cohort study aimed to evaluate the incidence, risk factors, and clinical outcomes of multiple viral infections in the first year following alloHCT.
Methods: All microbiologically confirmed viral infection of CMV, Epstein-Barr virus (EBV), BK polyomavirus (BKV), varicella zoster virus, human herpesvirus 6, herpes simplex virus, and various respiratory viruses were reviewed up to 12 months post-alloHCT.
Results: Among 430 alloHCT recipients, 744 viral infections were observed within the first year posttransplantation, predominantly CMV (55%), followed by EBV (51%) and BKV (21%). Eighty-five percent of patients had at least 1 viral infection, of which 34% had 2 and 24% had ≥3 viruses. Independent risk factors of multiple viral infections included CMV serostatus (R+/D-: hazard ratio [HR], 2.59 [95% confidence interval {CI}, 2.03-3.30]; R-/D+: HR, 2.25 [95% CI, 1.66-3.05]), haploidentical donor (HR, 1.56 [95% CI, 1.18-2.06]), T-cell depletion use (HR, 1.44 [95% CI, 1.11-1.88]), and grade III-IV acute graft-versus-host disease (HR, 1.44 [95% CI, 1.15-1.80]). Patients experiencing multiple viral infections (≥3 vs 2 vs 1) had an earlier time to onset of first infection (median, 18 vs 25 vs 40 days), were hospitalized for an increased number of days (median, 53 vs 40 vs 37 days), and had lower survival probability at day 270 following infusion (P = .044).
Conclusions: Multiple viral infections were frequently observed, with a significant impact on morbidity and mortality following alloHCT.
期刊介绍：
Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.
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