Early human cytomegalovirus replication after transplantation is associated with a decreased relapse risk: evidence for a putative virus-versus-leukemia effect in acute myeloid leukemia patients

被引：259

作者：

Elmaagacli, Ahmet H. ^{[1
]}

Steckel, Nina K. ^{[1
]}

Koldehoff, Michael ^{[1
]}

Hegerfeldt, Yael ^{[1
]}

Trenschel, Rudolf ^{[1
]}

Ditschkowski, Markus ^{[1
]}

Christoph, Sandra ^{[1
]}

Gromke, Tanja ^{[1
]}

Kordelas, Lambros ^{[1
]}

Ottinger, Hellmut D. ^{[1
]}

Ross, Rudolf S. ^{[2
]}

Horn, Peter A. ^{[3
]}

Schnittger, Susanne ^{[4
]}

Beelen, Dietrich W. ^{[1
]}

机构：

[1] Univ Duisburg Essen, Dept Bone Marrow Transplantat, W German Canc Ctr, Univ Hosp Essen, D-45122 Essen, Germany

[2] Univ Duisburg Essen, Inst Virol, Univ Hosp Essen, D-45122 Essen, Germany

[3] Univ Duisburg Essen, Inst Transfus Med, Univ Hosp Essen, D-45122 Essen, Germany

[4] Munich Leukemia Lab, Munich, Germany

来源：

BLOOD | 2011年 / 118卷 / 05期

关键词：

STEM-CELL TRANSPLANTATION; BONE-MARROW; HOST-DISEASE; PP65; ANTIGENEMIA; REDUCED RISK; T-CELLS; CMV; RECIPIENTS; DONORS; RECONSTITUTION;

D O I：

10.1182/blood-2010-08-304121

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

The impact of early human cytomegalovirus (HCMV) replication on leukemic recurrence was evaluated in 266 consecutive adult (median age, 47 years; range, 18-73 years) acute myeloid leukemia patients, who underwent allogeneic stem cell transplantation (alloSCT) from 10 of 10 high-resolution human leukocyte Ag-identical unrelated (n = 148) or sibling (n = 118) donors. A total of 63% of patients (n = 167) were at risk for HCMV reactivation by patient and donor pretransplantation HCMV serostatus. In 77 patients, first HCMV replication as detected by pp65-antigenemia assay developed at a median of 46 days (range, 25-108 days) after alloSCT. Taking all relevant competing risk factors into account, the cumulative incidence of hematologic relapse at 10 years after alloSCT was 42% (95% confidence interval [CI], 35%-51%) in patients without opposed to 9% (95% CI, 4%-19%) in patients with early pp65-antigenemia (P < .0001). A substantial and independent reduction of the relapse risk associated with early HCMV replication was confirmed by multivariate analysis using time-dependent covariate functions for grades II to IV acute and chronic graft-versus-host disease, and pp65-antigenemia (hazard ratio = 0.2; 95% CI, 0.1-0.4, P < .0001). This is the first report that demonstrates an independent and substantial reduction of the leukemic relapse risk after early replicative HCMV infection in a homogeneous population of adult acute myeloid leukemia patients. (Blood. 2011; 118(5): 1402-1412)

引用

页码：1402 / 1412

页数：11

共 35 条

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