Co-Reactivation of Cytomegalovirus and Epstein-Barr Virus Was Associated With Poor Prognosis After Allogeneic Stem Cell Transplantation

Abstract

Reactivation of cytomegalovirus (CMV) or Epstein-Barr virus (EBV) is common after hematopoietic stem cell transplantation (HSCT). Previous researches have demonstrated that either CMV or EBV reactivation is associated with poor outcomes of HSCT. However, few studies investigate the impact of CMV and EBV co-reactivation after HSCT. In this study, we described the clinical characteristics of HSCT recipients with CMV and EBV co-reactivation (defined as CMV and EBV viremia occur at the same period of time). We conducted a longitudinal study of 247 patients who underwent HSCT in our center. A total of 24 (9.7%) patients had CMV and EBV co-reactivation. These patients showed higher incidence of viral pneumonitis (P=0.005). Patients with CMV and EBV co-reactivation had significant lower 1-year overall survival (OS) (P=0.004) and lower 1-year leukemia free survival (LFS) (P=0.016). Our further analysis suggested that duration of CMV (P=0.014), EBV (P<0.001), and CD4+CD25+ T cell counts at day 30 post-transplantation (P=0.05) are independent risk factors of virus co-reactivation. In conclusion, patients who developed co-reactivation of CMV and EBV had poor prognosis in terms of lower 1-year OS and LFS, and the CMV and EBV co-reactivation was associated with prolonged CMV or EBV duration and poor CD4+CD25+ T cell reconstitution at day 30 post-transplantation.

Immune Reconstitution of Patients Who Recovered From Steroid-Refractory Acute Graft-Versus-Host Disease After Basiliximab Treatment

“…CD28-mediated costimulation was very important in T-cell activation; CD4 + CD28 + T cells and CD8 + CD28 + T cells mediated graft-versus-leukemia (GVL) effect to prevent relapse, and CD4 + CD28 + T cells also mediated protection against infections ( 49 , 50 ). Poor CD4 + CD25 + T cell reconstitution increased the risk of infections ( 51 ). We observed that patients who recovered from SR-aGVHD after basiliximab treatment had a slower CD4 + CD25 + T-cell recovery compared with event-free HID HSCT recipients, which was supported by previous studies ( 52 , 53 ).…”

Risk factors and outcome of concurrent and sequential multiviral cytomegalovirus, Epstein–Barr virus, BK virus, adenovirus and other viral reactivations in transplantation

“…Studies consistently identified immunosuppression as the primary risk for multivirus infections (Table 1) [24,41,43]. Risk factors such as D/R HLA mismatch, unrelated donors, severe acute GVHD, myeloablative conditioning, lymphopenia, and use of lymphocyte-depleting agents were identified [22 ▪▪ ,46 ▪▪ ,47]. Of recipient factors, CMV seropositivity and increased age were also found to be associated with multiviral infections [22 ▪▪ ,44].…”

Recent Advancements in Poor Graft Function Following Hematopoietic Stem Cell Transplantation

“…CMV and Epstein-Barr virus reactivation are independent risk factors for sPGF within the first 100 days of allo-HSCT ( 4 , 88 ). CMV and Epstein-Barr virus co-reactivation not only leads to a shorter 1-year OS and leukemia-free survival, but also results in poor regulatory T cell reconstitution at day 30 after allo-HSCT ( 89 ). CMV reactivation (CMVR) after HSCT can lead to a variety of common life-threatening infectious complications such as pneumonia, retinitis, or sPGF.…”