急性髓系白血病异基因造血干细胞移植后巨细胞病毒血症对白血病复发的影响

Impact of human cytomegalovirus viremia on relapse after allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia patients

目的 探讨急性髓系白血病（AML）患者异基因造血干细胞移植（allo-HSCT）后巨细胞病毒（CMV）感染对白血病复发的影响.方法 回顾性分析2005年1月至2014年1月中山大学附属中山医院血液内科接受allo-HSCT的62例AML患者（除外急性早幼粒细胞性白血病）,观察患者移植后白血病复发与CMV感染及供受者临床特征的关系.结果 单因素分析显示,初诊时白细胞＞100×10^9/L、疾病高危、移植后环孢素浓度低于200 μg/L的患者复发率高,而移植后CMV阳性及慢性GVHD患者复发率低;Cox多因素分析显示,疾病高危（RR=3.296,95％ CI：1.274～8.530,P＝0.014）、无慢性GVHD（RR =0.167,95％ CI：0.042～0.668,P=0.011）及CMV阴性（RR＝0.285,95％CI：0.084 ～0.973,P=0.045）是移植后复发的独立危险因素.结论 AML患者allo-HSCT后CMV血症是影响复发的有利因素之一.

Objective To explore the relationship between cytomegalovirus （CMV） infection and risk factors for relapsing patients with acute myeloid leukemia（AML） （non-acute promyelocytic leukemia） after hematopoietic stem cell transplantation （HSCT）.Methods A total of 62 allo-HSCT patients from January 2005 to January 2014 were enrolled and analyzed retrospectively.And the clinical characteristics of donors and recipients and post-transplantation relapse were recorded.Results Single factor analysis indicated that there were 5 risk factors correlated with disease relapse （P 〈0.05）.Leucocytosis （〉 100 × 10^9/L）,high-risk AML and cyclosporine A concentration under 200 μg/L were correlated with high relapsing rates while CMV reaction and chronic graft versus host disease had a low relapsing rate.Cox regression analysis revealed that high-risk AML （RR =3.296,95% CI：1.274-8.530,P =0.014）,CMV negativity （RR =0.285,95 % CI：0.084-0.973,P =0.045） and non-chronic GVHD （RR =0.167,95 % CI：0.042-0.668,P =0.011） were major risk factors of relapse.Conclusion Human CMV viremia after allo-HSCT has a decreased relapsing risk in patients with AML.