儿童重型β地中海贫血造血干细胞移植后CMV感染预后分析

Prognostic analysis of CMV infection after allogeneic hematopoietic stem cell transplantation in children withβThalassemia major

目的探讨移植后CMV感染对儿童重型β地中海贫血造血干细胞移植术后生存预后的影响。方法回顾2013年9月—2019年9月诊断重型β地中海贫血并接受异基因造血干细胞细胞移植的257例患者资料,通过定量PCR方法监测移植后CMV感染,采用Log-Rank及Cox回归,分析CMV对移植后的生存预后影响。结果随访中位时间29个月,有71例(27.6%)发生CMV感染。CMV感染组与无感染组中aGVHD发生率分别为47.9%和25.3%(P=0.001),可逆性后部脑白质病变发生率分别为16.9%和4.8%(P=0.002),出血性膀胱炎发生率分别为36.6%和21.5%(P=0.013),合并EB病毒感染者分别为29.6%和12.9%(P=0.002)。CMV组与无感染组的5年OS分别为83.6%和95.2%(P=0.004),TFS分别为83.6%和93.5%(P=0.021),TRM分别为16.4%和4.9%(P=0.004),GR分别为0%和1.7%(P=0.302)。Cox回归多因素分析提示CMV感染是影响移植后OS、TFS、TRM的独立危险因素。结论儿童重型β地中海贫血患者行造血干细胞移植后,CMV感染是影响OS、TFS、TRM的独立危险因素。

Objective To investigate the survival prognosis of cytomegalovirus(CMV)infection after allogeneic hematopoietic stem cell transplantation(allo-HSCT)in children withβthalassemia major.Methods Clinical data of 257βthalassemia major children with allo-HSCT from 2013 September to 2019 September were analyzed retrospectively.CMV infection was monitored by quantitative PCR method for detecting the level of CMV-DNA.Log-rank test and Cox regression analysis were used to determine the effect of CMV to on survival and prognosis after transplantation.Results The median follow-up time was 29 months.CMV infection occurred in 71 of 257 patients(27.6%).About 47.9%and 25.3%of patients manifested acute graft versus host disease(aGVHD)in CMV infected and CMV-uninfected groups(P=0.001).About 16.9%and 4.8%of patients manifested posterior reversible encephalopathy syndrome in CMV infected and CMV-uninfected groups(P=0.002).About 36.6%and 21.5%of patients manifested hemorrhagic cystitis in CMV infected and CMV-uninfected groups(P=0.013).About 29.6%and 12.9%of patients manifested EBV infection in CMV infected and CMV-uninfected groups(P=0.002).The 5-year Overall Survival(OS)rates of CMV group and CMV-uninfected group were 83.6%and 95.2%,respectively(P=0.004).The 5-year thalassemia free survival(TFS)rates were 83.6%and 93.5%(P=0.021),respectively.The 5-year transplant related mortality(TRM)rates were 16.4%and 4.9%(P=0.004),respectively.The 5-year graft rejection(GR)rates was 0%and 1.7%(P=0.302),respectively.Cox proportional hazards regression model multivariate analysis showed that CMV infection is an independent risk factor for OS、TFS and TRM after transplantation.Conclusions After allo-HSCT in children withβthalassemia,CMV infection is an independent risk factor for OS、TFS and TRM.