Timing of CMV-specific effector memory T cells predicts viral replication and survival after allogeneic hematopoietic stem cell transplantation

被引:12
作者
Espigado, Ildefonso [1 ,2 ]
de la Cruz-Vicente, Fatima [1 ,2 ]
BenMarzouk-Hidalgo, Omar J. [1 ,3 ]
Gracia-Ahufinger, Irene [1 ,3 ]
Garcia-Lozano, Jose R. [1 ,4 ]
Aguilar-Guisado, Manuela [1 ,3 ]
Cisneros, Jose M. [1 ,3 ]
Urbano-Ispizua, Alvaro [1 ,2 ]
Perez-Romero, Pilar [1 ,3 ]
机构
[1] Univ Seville, Inst Biomed Sevilla IBIS, CSIC, Hosp Univ Virgen del Rocio, Seville 41013, Spain
[2] Hosp Univ Virgen del Rocio, Dept Hematol, Seville, Spain
[3] Hosp Univ Virgen del Rocio, Unit Infect Dis Microbiol & Prevent Med, Seville, Spain
[4] Hosp Univ Virgen del Rocio, Serv Immunol, Seville, Spain
关键词
allogeneic stem cell transplantation; cytomegalovirus infection; cytomegalovirus-specific immune response; CYTOMEGALOVIRUS-SPECIFIC CD4(+); VERSUS-HOST-DISEASE; HIGH-RISK; IMMUNE RECONSTITUTION; BONE-MARROW; RECIPIENTS; INFECTION; CD8(+); REACTIVATION; SEROSTATUS;
D O I
10.1111/tri.12406
中图分类号
R61 [外科手术学];
学科分类号
摘要
The aim of this study was to characterize timing, kinetic, and magnitude of CMV-specific immune response after hematopoietic stem cell transplantation (HSCT) and its ability to predict CMV replication and clinical outcomes. Using cell surface and intracellular cytokine staining by flow cytometry, CMV-specific T-cell response was measured in blood, while CMV viral load and chimerism were determined by real-time PCR. Patients that reconstituted CMV-specific T-cell response within 6weeks after Allo-SCT showed a more robust immune response (CD8(+): 0.7cells/l vs. 0.3/l; P-value=0.01), less incidence of CMV replication (33% vs. 89.5%; P-value=0.007), reduced viral loads (1.81 log copies/ml vs. 0 copies/ml; P-value=0.04), and better overall survival (72%; CI: 0.53-0.96 vs. 42% CI: 0.24-0.71; P-value=0.07) than patients with a delayed immune reconstitution. Viremic patients had significantly higher transplant-related mortality than nonviremic patients after 1year (33% CI: 0.15-0.52 vs. 0% CI: 0.05-0.34; P-value=0.01). Risk factors independently associated with viral replication were receptor pretransplant CMV-positive serostatus (P-value=0.02) and acquiring CMV-specific T-cell response after 6weeks post-transplantation (P-value=0.009). In conclusion, timing of acquiring a positive CMV-specific T-cell immune response after transplantation may identify patients with different risk for viral replication and different clinical outcomes, including survival.
引用
收藏
页码:1253 / 1262
页数:10
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