异基因造血干细胞移植后腺病毒感染26例诊治分析

Diagnosis and treatment of 26 cases of adenovirus infection after allogeneic hematopoietic stem cell transplantation

目的分析异基因造血干细胞移植后腺病毒感染患者的临床特征及预后。方法收集2018-2022年苏州大学附属第一医院移植后病房收治的26例异基因造血干细胞移植后腺病毒感染患者,分析患者基本资料、临床特征、治疗和随访情况。结果26例患者中位年龄30(22,44)岁。22例(84.62%)接受亲缘单倍体造血干细胞移植,3例(11.54%)接受无关移植,1例(3.85%)接受脐血干细胞移植。25例(96.15%)预处理方案中包含ATG。腺病毒感染发生的中位时间为移植后95(44,152)d。中位外周血淋巴细胞计数为0.30(0.11,0.69)×10^(9)/L。12例(46.15%)合并急性移植物抗宿主病。24例(92.31%)在诊断时仍接受抗排异治疗。16例(61.54%)患者除腺病毒感染外,合并其他感染。8例(30.77%)为无症状感染,18例(69.23%)为腺病毒病:肺炎(38.89%)、胃肠炎(38.89%)、脑炎(33.33%)、肝炎(5.56%)、泌尿道炎症(5.56%)。年龄>30岁是发生腺病毒病的危险因素(P=0.03)。18例(69.23%)进行免疫抑制剂减撤治疗,所有患者均使用至少一种抗病毒药物,其他治疗包括大剂量丙种球蛋白及供者淋巴细胞输注。10例(38.46%)腺病毒感染好转,16例(61.54%)进展或无效。中位随访时间为30(7,237)d,22例患者死亡。全因死亡率为(88.5±7.1)%,归因死亡率为45.5%,无症状感染者与腺病毒病患者100 d生存率差异无统计学意义(37.5%对22.2%,HR=1.83,95%CI 0.66~5.04,P=0.24)。结论年龄>30岁是发生腺病毒病的危险因素,异基因造血干细胞移植后腺病毒感染患者死亡率较高。

Objective To analyze the clinical characteristics and prognosis of adenovirus infection after allogeneic hematopoietic stem cell transplantation.Methods A total of 26 patients with adenovirus infection admitted to the posttransplant ward of the First Affiliated Hospital of Soochow University from 2018 to 2022 were enrolled.Their data on baseline and clinical characteristics,treatment,and follow-up were analyzed.Results The median patient age was 30(22,44)years.Twenty-two patients received related haploid stem cell transplantation,three received unrelated stem cell transplantation,and one received umbilical cord stem cell transplantation.Antithymocyte globulin was included in the conditioning regimen in 25 patients.The median time of adenovirus infection was+95(+44,+152)days.The median peripheral blood lymphocyte count was 0.30(0.11,0.69)×10^(9)/L.Twelve patients had acute graft-versus-host disease.Twenty-four patients received antirejection therapies at diagnosis.Sixteen cases had combined infection with other pathogens with adenovirus infection.Eight cases were diagnosed as asymptomatic infection,and 18 were diagnosed as adenovirus disease,including pneumonia(38.89%),gastrointestinal disease(38.89%),encephalitis(33.33%),hepatitis(5.56%),and urinary tract inflammation(5.56%).The age of>30 years was a risk factor for adenovirus disease(P=0.03).Eighteen patients received tapering of immunosuppression,and all 26 patients received at least one antiviral drug.Other treatments included high-dose gamma globulin and donor lymphocyte infusion.Adenovirus infection improved in 10 cases and progressed in 16 cases.The median follow-up time was 30(7,237)days.Twenty-two patients died.The all-cause mortality rate was(88.5±7.1)%,and the attributable mortality rate was 45.5%.There was no significant difference in the 100 d survival rate between asymptomatic infected patients and patients diagnosed with adenovirus disease(37.5%vs 22.2%,HR=1.83,95%CI 0.66-5.04,P=0.24).Conclusion The age of>30 years was a risk factor for adenovirus disease.Mortality was high in patients with adenovirus infection after allogeneic hematopoietic stem cell transplantation.