再生障碍性贫血患者亲缘单倍体异基因造血干细胞移植后EB病毒感染危险因素及生存分析  

Risk factors and survival of EBV-infected aplastic anemia patients after haploid allogeneic hematopoietic stem cell transplantation

作　　者：张新荷 冯佳 谭正伟 赵越超 胡慧瑾[2] 陈均法[2] 武利强[2] 俞庆宏[2] 吴迪炯[2] 叶宝东[2] 刘文宾[2] ZHANG Xin-he;FENG Jia;TAN Zheng-wei;ZHAO Yue-chao;HU Hui-jin;CHEN Jun-fa;WU Li-qiang;YU Qing-hong;WU Di-jiong;YE Bao-dong;LIU Wen-bin(The First Clinical College,Zhejiang Chinese Medical University,Hangzhou 310006,China;Department of Hematology,The First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310006,China)

机构地区：[1]浙江中医药大学第一临床医学院,浙江杭州310006 [2]浙江中医药大学附属第一医院血液科,浙江杭州310006

出　　处：《中国感染控制杂志》2024年第10期1228-1235,共8页Chinese Journal of Infection Control

摘　　要：目的分析再生障碍性贫血(AA)患者进行单倍体异基因造血干细胞移植(Haplo-HSCT)后EB病毒(EBV)感染危险因素及患者生存情况。方法回顾性分析2019年1月1日-2022年10月31日某院血液科78例进行Haplo-HSCT的AA患者临床资料,观察EBV血症、临床诊断的EBV相关性疾病(EBV病)及淋巴细胞增殖性疾病(PTLD)发生情况及出现时间,并分析其危险因素及生存情况。结果78例患者中男性38例,女性40例,中位年龄33(9~56)岁,其中53例患者发生EBV再激活,总发生率67.9%,发生EBV再激活的中位时间为移植后33(13,416)d。EBV再激活患者中,单纯EBV血症49例(62.8%),可能的EBV疾病2例(2.6%),已经证实的EBV疾病(PTLD)2例(2.6%)。单因素提示,移植时患者年龄<40岁、脐血辅助回输、移植后发生急性移植物抗宿主病(aGVHD)、合并巨细胞病毒(CMV)感染是AA患者进行Haplo-HSCT后发生EBV再激活的独立危险因素,多因素分析提示合并CMV感染是AA患者进行Haplo-HSCT后发生EBV再激活的独立危险因素(P=0.048)。干细胞回输前使用利妥昔单抗干预是EBV再激活时间长短的影响因素(P<0.05)。单纯EBV血症病死率为8.2%,EBV病病死率为50.0%,PTLD病死率为100%。EBV再激活患者2年总生存率为85.3%,EBV未激活患者2年生存率为90.7%,差异无统计学意义(P=0.897),但应用利妥昔单抗治疗的患者其2年生存率低于未使用的患者,差异有统计学意义(P=0.046)。结论EBV再激活是AA患者进行Haplo-HSCT后常见的严重并发症之一,影响患者的预后和生存。Objective To analyze the risk factors and survival status of Epstein-Barr virus(EBV)infection in patients with aplastic anemia(AA)after haploid allogeneic hematopoietic stem cell transplantation(Haplo-HSCT).Methods Clinical data of 78 AA patients who underwent Haplo-HSCT in the hematology department of a hospital from January 1,2019 to October 31,2022 were analyzed retrospectively.The occurrence and onset time of EBV viremia,EBV-related diseases(EBV diseases),and post-transplant lymphoproliferative disorders(PTLD)were observed,risk factors and survival status were analyzed.Results Among the 78 patients,38 were males and 40 were females,with a median age of 33(9-56)years old;53 patients experienced EBV reactivation,with a total incidence of 67.9%,and the median time for EBV reactivation was 33(13,416)days after transplantation.Among patients with EBV reactivation,49 cases(62.8%)were simple EBV viremia,2 cases(2.6%)were possible EBV di-seases,and 2 cases(2.6%)were already confirmed EBV diseases(PTLD).Univariate analysis showed that age 1<40 years old at the time of transplantation,umbilical cord blood infusion,occurrence of acute graft-versus-host disease(aGVHD)after transplantation,and concurrent cytomegalovirus(CMV)infection were independent risk factors for EBV reactivation in AA patients after Haplo-HSCT.Multivariate analysis showed that concurrent CMV infection was an independent risk factor for EBV reactivation in AA patients after Haplo-HSCT(P=0.048).Ritu-ximab intervention before stem cell reinfusion was a factor affecting the duration of EBV reactivation(P<0.05).The mortality of EBV viremia,EBV diseases,and PTLD alone were 8.2%,50.0%,and 100%,respectively.The 2-year overall survival rate of patients with and without EBV reactivation were 85.3%,and 90.7%,respectively,difference was not statistically significant(P=0.897).However,patients treated with rituximab had 2-year lower survival rate than those who did not use it,with a statistically significant difference(P=0.046).Conclusion EBV reactivation is one o

关 键 词：再生障碍性贫血 单倍体造血干细胞移植 EB病毒 淋巴增殖性疾病 

分 类 号：R181.32[医药卫生—流行病学]