Objective: To explore the clinical characteristics and risk factors of cytomegalovirus(CMV) and Epstein-Barr virus(EBV) co-reactivation after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and its influence on prognosis.
Methods: The clinical data of 222 patients who received allo-HSCT from January 2015 to December 2020 were collected, and the patients were divided into groups according to the occurrence of CMV and EBV infection. Kaplan-Meier method was used for survival analysis, and Cox proportional hazard regression model was used to analyze the risk factors of co-reactivation of CMV and EBV.
Results: After allo-HSCT, there were 30 patients with co-reactivation of CMV and EBV (CMV++EBV+ group), 101 patients with CMV viremia (CMV+ group), 149 patients with EBV viremia (EBV+ group), and 28 patients with CMV and EBV inactivation (CMV-+ EBV- group). Compared with the other groups, the incidence of acute graft-versus-host disease (aGVHD) and hemorrhagic cystitis (HC) was higher in CMV++ EBV+ groups (53.3% vs 42.6%, 36.9%, 17.9%, P < 0.001; 36.7% vs 32.7%, 22.8%, 10.7%, P =0.042). The incidence of post-transplant lymphoproliferative disease (PTLD) in CMV++ EBV+ group was similar to CMV+ group and EBV+ group (3.3% vs 3.0%, 3.4%, P =0.811). Univariate and multivariate analysis showed that the persistent time of CMV and EBV after transplantation were independent risk factors for co-reactivation of CMV and EBV. Compared with the other groups, the 2-year overall survival (OS) rate and 2-year disease-free survival (DFS) rate of patients in CMV++EBV+ group were lower (46.7% vs 74.9%, 83.4%, 71.4%, P < 0.001; 46.7% vs 70.9%, 79.5%, 69.9%, P =0.002), and 2-year non-recurrence mortality (NRM) was higher (48.2% vs 22%, 13.6%, 18.7%, P <0.001).
Conclusion: The persistent time of CMV and EBV after transplantation are independent risk factors for patients with co-reactivation of CMV and EBV. Patients with co-reactivation of CMV and EBV had lower OS and DFS rate and higher NRM, suggesting that the clinical prognosis of the patients are worse.
题目: 异基因造血干细胞移植后CMV和EBV共激活患者的临床研究.
目的: 探讨异基因造血干细胞移植（allo-HSCT）后巨细胞病毒（CMV）和EB病毒（EBV）共激活患者的临床特点、危险因素及其对预后的影响。.
方法: 收集2015年1月至2020年12月接受allo-HSCT的222例患者临床资料，根据是否发生CMV、EBV感染进行分组，采用Kaplan-Meier法进行生存分析，Cox比例风险回归模型分析CMV、EBV共激活的危险因素。.
结果: allo-HSCT后发生CMV和EBV共激活患者（CMV++EBV+组，即CMV及EBV合并感染）30例，CMV血症患者（CMV+组）101例，EBV血症患者（EBV+组）149例，CMV、EBV未激活患者（CMV-+ EBV-组）28例。与其他组相比，CMV+ +EBV+组中急性移植物抗宿主病、出血性膀胱炎发生率更高（53.3% vs 42.6%、36.9%、17.9%，P <0.001； 36.7% vs 32.7%、22.8%、10.7%，P =0.042)。CMV+ +EBV+组与CMV+组、EBV+组移植后淋巴细胞增殖性疾病患者的发生率类似（3.3% vs 3.0%、3.4%，P =0.811）。单因素及多因素分析结果显示，移植后CMV+持续时间、EBV+持续时间是CMV和EBV共激活患者的独立危险因素。与其他组相比，CMV+ +EBV+组患者2年总生存率、2年无病生存率较低（46.7% vs 74.9%、83.4%、71.4%，P <0.001；46.7% vs 70.9%、79.5%、69.9%，P =0.002），2年非复发死亡率较高（48.2% vs 22%、13.6%、18.7%，P <0.001）。.
结论: 移植后CMV+持续时间、EBV+持续时间是CMV和EBV共激活患者的独立危险因素。CMV和EBV共激活患者的总生存率、无病生存率更低，非复发死亡率更高，临床预后更差。.
Keywords: allogeneic hematopoietic stem cell transplantation; cytomegalovirus; Epstein-Barr virus; co-reactivation; prognosis.