儿童脐血移植后巨细胞病毒活化的危险因素及其与T细胞重建的相关性  

Risk factors of cytomegalovirus activation after cord blood transplantation in children and the correlation between CMV activation and T lymphocyte reconstitution

作　　者：刘敏媛 李泊涵 吉奇 张森林 张志奇 杨晨唯 刘露 张晖 夏子豪 汪书然 肖佩芳[1] 卢俊[1] 李捷[1] 胡绍燕[1] LIU Minyuan;LI Bohan;JI Qi;ZHANG Senlin;ZHANG Zhiqi;YANG Chenwei;LIU Lu;ZHANG Hui;XIA Zihao;WANG Shuran;XIAO Peifang;LU Jun;LI Jie;HU Shaoyan(Department of Hematology and Oncology,Children′s Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属儿童医院血液科,苏州215000

出　　处：《中国小儿血液与肿瘤杂志》2024年第3期194-199,共6页Journal of China Pediatric Blood and Cancer

基　　金：国家自然基金课(81970163,82170218);江苏省重点课题(BE2021654);苏州市课题(SZS2023014,SKY2022012,SZS201615)。

摘　　要：目的 探讨儿童白血病接受脐带血移植后巨细胞病毒(CMV)活化的危险因素及其与T淋巴细胞重建的相关性。方法 回顾性分析2016年1月—2021年12月在苏州大学附属儿童医院血液科行脐带血造血干细胞移植的白血病患儿的临床资料及CMV活化的发生率,并分析单次及多次CMV活化对T淋巴细胞重建的影响,最后随访时间是2022年12月。结果 共纳入75例患儿,移植100d内53例发生CMV活化,18例表现为难治性。单因素分析示:预处理使用ATG是CMV活化的危险因素(P=0.043);移植时HLA配型不合、发生Ⅱ-Ⅳ度aGVHD是难治性CMV活化的危险因素(P<0.01);多因素分析示:发生Ⅱ-Ⅳ度aGVHD是难治性CMV活化的独立危险因素(P=0.021);发生多次CMV活化者移植后1年内CD4^(+)细胞重建延迟。移植后1个月内CMV活化对总体生存率无明显影响,CMV活化的AML患儿累积复发率下降。结论 预处理使用ATG是白血病儿童脐血移植后CMV活化的危险因素,供-受体HLA配型不合、发生Ⅱ-Ⅳ度aGVHD是发生难治性CMV感染的危险因素;多次CMV活化影响CD4^(+)细胞重建。Objective To investigate the risk factors for cytomegalovirus(CMV) activation after cord blood transplantation(CBT) in children with leukemia and the correlation between CMV activation and T lymphocyte reconstitution.Methods The clinical data of children with leukemia who underwent CBT in the Department of Hematology of Children′s Hospital of Soochow University from January 2016 to December 2021 were retrospectively analyzed.The associated factors of CMV activation were analyzed,and the effect of single and multiple activation on T lymphocyte reconstitution were compared.The last follow-up period was December 2022.Results A total of 75 patients were enrolled in this study.CMV activation occurred in 53 patients within 100 days after CBT.A total of 18 children(34%) developed refractory CMV activation.Univariate analysis showed that the use of ATG in conditioning regimen was a risk factor for CMV activation(P=0.043).HLA mismatch and Ⅱ-Ⅳ aGVHD were risk factors for refractory CMV activation(P<0.01).Multivariate analysis showed that Ⅱ-Ⅳ aGVHD was an independent risk factor for refractory CMV activation(P=0.021).The reconstitution of CD4^(+)T cells in patients with multiple CMV activation was delayed within 1 year after CBT.CMV activation within one month after CBT has no significant effect on overall survival,the cumulative relapse rate of AML children with CMV activation decreased.Conclusions The use of ATG as conditioning regimen is a risk factor for CMV activation within 100 days after CBT in children with leukemia.Donor-recipient HLA mismatch and grade Ⅱ-Ⅳ aGVHD are risk factors for refractory CMV activation.Multiple CMV activation affects CD4^(+) cell reconstitution.

关 键 词：脐血 造血干细胞移植 巨细胞病毒 难治性 T淋巴细胞 

分 类 号：R457.7[医药卫生—治疗学] R733.7[医药卫生—临床医学]