Objective: To retrospectively analyze the impact of primary PGF on CMV pneumonia in patients who have undergone haplo-HSCT. Methods: The clinical data of 122 patients who underwent haplo-HSCT at the Peking University Institute of Hematology from 2011-2012 were retrospectively reviewed. The incidence rate of CMV pneumonia between PGF and good graft function (GGF) was compared, and the factors were analyzed. In addition, outcomes in PGF patients with CMV pneumonia have been described. Results: Total 122 patients were retrospectively reviewed, and of these, 26 (21.3% ) had PGF, while 96 (78.7% ) had GGF. In addition, 15 patients had CMV pneumonia, and the median time to the development of CMV pneumonia was 103 (31-262) days; the 1-year cumulative incidence of CMV pneumonia was 12.3% (95% CI 6.2% -18.4% ) . In patients with primary PGF and GGF after Haplo-HSCT, the incidence of CMV pneumonia was 30.8% (8/26) and 7.3% (7/96) , respectively (P=0.002) . Moreover, 24 patients had CMV viremia (92.3% ) , while of the 96 GGF patients, 79 (82.3% ) had CMV viremia (P=0.212) . In multivariate analysis, the results showed that primary PGF had a significant influence on CMV pneumonia (P=0.005) . Compared with those without CMV pneumonia, patients with CMV pneumonia had poorer overall survival 37.3% (95% CI 11.2% -63.4% ) vs. 78.9% (95% CI 72.0% -87.6% ) (χ(2)=16.361, P<0.001) . The 1-year overall survival (OS) was 25.0% (95% CI 0% -55.0% ) and 50.0% (95% CI 26.9% -73.1% ) (χ(2)=4.656, P=0.031) in PGF patients with (8/26) and without (18/26) CMV pneumonia. Conclusion: The incidence of cytomegalovirus pneumonia in patients with primary poor graft function increases and the survival rate decreases.
目的： 研究单倍型造血干细胞移植（haplo-HSCT）后原发性植入功能不良（PGF）对巨细胞病毒（CMV）肺炎发生及预后的影响。 方法： 对2011年1月至2012年12月在北京大学血液病研究所接受haplo-HSCT的122例血液病患者进行回顾性分析。 结果： 122例患者中，移植后26例（21.3％）发生原发性PGF（PGF组），其余96例（78.7％）患者植入功能良好（GGF组）。共15例（12.3％）患者发生CMV肺炎，中位发生时间为移植后103（31～262）d，1年累积发生率为12.3％（95％CI 6.2％～18.4％）。PGF组、GGF组CMV肺炎发生率分别为30.8％（8/26）、7.3％（7/96）（P＝0.002），CMV血症发生率分别为92.3％（24/26）、82.3％（79/96）（P＝0.212）。多因素分析显示原发性PGF是CMV肺炎发生的影响因素（P＝0.005）。发生CMV肺炎患者的总生存（OS）率低于未发生CMV肺炎患者[37.3％（95％CI 11.2％～63.4％）对78.9％（95％CI 72.0％～87.6％），χ(2)＝16.361，P<0.001]。PGF组CMV肺炎患者移植后1年OS率低于非CMV肺炎患者[25.0％（95％CI 0％～55.0％）对50.0％（95％CI 26.9％～73.1％），χ(2)＝4.656，P＝0.031]。 结论： haplo-HSCT后发生原发性PGF的血液病患者有较高的CMV肺炎发生率且移植后1年OS率较低。.
Keywords: Cytomegalovirus pneumonia; haploidentical stem cell transplantation; primary poor graft function.