Increased Epstein‒Barr virus reactivation following prophylaxis for cytomegalovirus infection after haploidentical haematopoietic stem cell transplantation

IF 29.5 1区 医学 Q1 HEMATOLOGY Journal of Hematology & Oncology Pub Date : 2024-10-12 DOI:10.1186/s13045-024-01612-y
Xin Kong, Ziyi Xu, Yanjun Wu, Xiaowen Tang, Shengli Xue, Miao Miao, Yue Han, Ying Wang, Suning Chen, Aining Sun, Huiying Qiu, Depei Wu, Ye Zhao, Feng Chen
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Abstract

Letermovir (LTV) prophylaxis is effective in reducing the incidence of clinically significant cytomegalovirus (CMV) infection (cs CMVi) after allogeneic haematopoietic stem cell transplantation (allo-HSCT). Since our centre began administering LTV prophylaxis in June 2022, we have observed a certain increase in the incidence of Epstein–Barr virus (EBV) reactivation after haploidentical HSCT. We retrospectively analysed 230 consecutive patients who underwent haploidentical HSCT with rabbit anti-thymocyte globulin (ATG) from October 2022 to June 2023. The LTV group included 133 patients who received LTV prophylaxis, and the control group included 97 patients who did not receive LTV prophylaxis. At 1 year after HSCT, EBV reactivation was observed in 36 patients (27%) in the LTV group and 13 patients (13%) in the control group (p = 0.012). All patients with EBV reactivation had EBV-DNAemia, and one patient in each group developed EBV-associated posttransplantation lymphoproliferative disorder (PTLD). The proportion of patients with low EBV-DNA loads (> 5 × 102 to < 1 × 104 copies/mL) was greater in the LTV group than in the control group (23% vs. 10%, p = 0.01). The proportion of patients with CMV reactivation was lower in the LTV group than in the control group (35% vs. 56%, p = 0.002). There was no significant difference between the groups in terms of neutrophil and platelet count recovery, the cumulative incidence of acute/chronic graft-versus-host disease, overall survival, cumulative relapse rate or nonrelapse mortality. Our results show that the increased incidence of EBV reactivation may be associated with LTV prophylaxis for CMV after haploidentical HSCT.
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单倍体造血干细胞移植后巨细胞病毒感染预防后的爱泼斯坦-巴氏病毒再活化增加
来替莫韦(LTV)预防性治疗可有效降低异基因造血干细胞移植(allo-HSCT)后临床重大巨细胞病毒(CMV)感染(cs CMVi)的发生率。自本中心于2022年6月开始实施LTV预防措施以来,我们观察到单倍体造血干细胞移植后爱泼斯坦-巴氏病毒(EBV)再活化的发生率有了一定程度的增加。我们回顾性分析了2022年10月至2023年6月期间连续接受兔抗胸腺细胞球蛋白(ATG)单倍体造血干细胞移植的230例患者。LTV组包括133名接受LTV预防治疗的患者,对照组包括97名未接受LTV预防治疗的患者。造血干细胞移植后 1 年,LTV 组有 36 名患者(27%)观察到 EBV 再激活,对照组有 13 名患者(13%)观察到 EBV 再激活(P = 0.012)。所有EBV再活化患者都患有EBV-DNA血症,每组各有一名患者出现EBV相关的移植后淋巴组织增生性疾病(PTLD)。低EBV-DNA载量(> 5 × 102 至 < 1 × 104拷贝/毫升)患者的比例在LTV组高于对照组(23% 对 10%,P = 0.01)。LTV组的CMV再激活患者比例低于对照组(35% 对 56%,P = 0.002)。在中性粒细胞和血小板计数恢复、急性/慢性移植物抗宿主病累积发病率、总生存率、累积复发率或非复发死亡率方面,两组间无明显差异。我们的研究结果表明,EBV再激活发生率的增加可能与单倍体造血干细胞移植后对CMV进行LTV预防有关。
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来源期刊
CiteScore
48.10
自引率
2.10%
发文量
169
审稿时长
6-12 weeks
期刊介绍: The Journal of Hematology & Oncology, an open-access journal, publishes high-quality research covering all aspects of hematology and oncology, including reviews and research highlights on "hot topics" by leading experts. Given the close relationship and rapid evolution of hematology and oncology, the journal aims to meet the demand for a dedicated platform for publishing discoveries from both fields. It serves as an international platform for sharing laboratory and clinical findings among laboratory scientists, physician scientists, hematologists, and oncologists in an open-access format. With a rapid turnaround time from submission to publication, the journal facilitates real-time sharing of knowledge and new successes.
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