单倍体相合造血干细胞移植后巨细胞病毒感染可能会减少急性髓系白血病复发

Cytomegalovirus infection after hapioidentical stem cell transplantation may reduce relapse risk in leukemia

目的探讨HIJA单倍体相合造血干细胞移植（haplo—HSCT）术后巨细胞病毒（CMV）感染与术后白血病复发的关系。方法回顾性分析2007年9月至2014年6月在南方医科大学珠江医院行haplo—HSCT的61例白血病患者资料，统计移植后生存率、复发率、CMV感染率及相关影响因素。结果36例患者在移植后出现CMV感染，移植后100d内的CMV感染发生率为59％。移植后出现CMV感染者的复发率明显低于未出现CMV感染的患者（16．9％比40．0％，P=0．034）。对疾病种类分层分析，发现移植后CMV感染同白血病复发减少的关系仅在AML患者中有统计学意义（P=0．019）。多因素分析显示，移植时处于复发状态的患者移植后死亡及复发风险增加（RR分别为2．866及3．331），而移植后发生CMV感染能够减少白血病的复发风险（RR=0．300，P=0．047）。结论haplo—HSCT术后CMV感染率仍然较高，接受haplo-HSCT的AML患者移植后出现CMV感染可能会减少白血病的复发。但由于CMV感染是移植后非复发死亡的重要原因，故本研究结果并不能改变现有的积极抗病毒治疗策略。

Objective： To analyze the-relationship between cytomegalovirus （CMV） reactivation and leukemia relapse after haploidentical hematopoietie stem cell transplantation （haplo-HSCT）. Methods A total of 61 patients diagnosed as hematological malignancies undergoing haplo-HSCT were analyzed retrospectively in our center. Results In the cohort, 36 patients had CMV reactivation after haplo-HSCT. The 100-day cumulative incidence of CMV reactivation was 59%. Compared with that in patients without CMV reactivation after transplantation, the incidence of leukemia relapse was lower in patients with CMV reactivation （ 16. 9% vs 40. 0%, P = 0.034）. The correlation of CMV reactivation and decreased relapse rate was only found in patients with acute myeloid leukemia （P = 0. 019 ）. In multivariate analysis, relapsed disease status before transplant was a significant negative predictor of overall survival （OS） and relapse after transplant （RR was 2. 866 and 3. 331 respectively）. CMV reactivation after transplant had a protective effect on disease relapse （RR = 0. 300, P = 0. 047）. Conclusions The rate of CMV reactivation after haplo-HSCT is high. CMV reactivation may reduce risk of relapse in patients diagnosed as acute myeloid leukemia undergoing haplo-HSCT. However, CMV reactivation is one of the important predictors of non-relapse death after transplant, active anti-viral treatment is still needed.