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目的:观察急性白血病患者接受异基因造血干细胞移植后Epstein-Barr病毒(EBV)血症的发生率,筛选其发生的高危因素,并评估EBV血症对移植预后的影响。方法:收集2012-01-2014-06于本中心接受异基因移植的急性白血病患者共501例的临床资料进行统计学分析,EBV血症检测采用实时定量PCR法检测外周血标本。结果:急性白血病患者移植后EBV血症2年累积发生率为22.1%±1.9%,不同类型白血病间发生率差异无统计学意义(P=0.406)。多因素分析结果显示,预处理中应用抗胸腺细胞球蛋白和单倍型供体是影响EBV血症发生率的独立危险因素。移植后EBV血症阴性和阳性患者2年总生存率分别为64.1%±2.3%和67.7%±5.7%,无白血病生存率分别为61.6%±2.3%和63.1%±6.0%,复发率分别为19.2%±2.1%和18.9%±5.3%,非复发死亡率分别为28.0%±2.2%和23.3%±4.3%,差异均无统计学意义。结论:EBV血症是急性白血病患者异基因移植后较为常见的并发症,预处理中应用抗胸腺细胞球蛋白和单倍型供体可显著升高EBV血症的发生率。通过积极监测及治疗,EBV血症不会显著降低移植预后。
OBJECTIVE: To investigate the incidence of Epstein-Barr virus (Epstein-Barr virus) after acute allogeneic hematopoietic stem cell transplantation in patients with acute leukemia and to screen for the risk factors of EBV. To evaluate the effect of EBV on the prognosis of transplant. Methods: The clinical data of 501 patients with acute leukemia receiving allogeneic transplantation in our center from January 2012 to June 2014 were collected for statistical analysis. Peripheral blood samples were collected by real-time PCR. Results: The cumulative incidence of 2-year post-transplantation EBV hyperlipidemia in patients with acute leukemia was 22.1% ± 1.9%. There was no significant difference in the incidence of leukemia among different types of leukemia (P = 0.406). Multivariate analysis showed that the application of anti-thymocyte globulin and haploids in pretreatment were independent risk factors for the incidence of EBV. The 2-year overall survival rates of patients with negative and positive post-transplantation EBV were 64.1% ± 2.3% and 67.7% ± 5.7%, respectively, and those without leukemia were 61.6% ± 2.3% and 63.1% ± 6.0%, respectively. The recurrence rates were 19.2% ± 2.1% and 18.9% ± 5.3% respectively. The non-recurrent mortality rates were 28.0% ± 2.2% and 23.3% ± 4.3% respectively, with no significant difference. Conclusion: EBV hyperlipidemia is a more common complication after allogeneic transplantation in patients with acute leukemia. Pretreatment with anti-thymocyte globulin and haploidentical donor can significantly increase the incidence of EBV. Through aggressive monitoring and treatment, EBV hyperlipidemia does not significantly reduce graft outcome.