血液造血干细胞移植后免疫受损患者的COVID-19:一个试点研究
Zilu Zhang1, Jingtao Huang1, Luxiang Wang1
1National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China.
Blood science (Baltimore, Md.)
|January 29, 2024
概括
血造干细胞移植 (HSCT) 患者的SARS-CoV-2感染率很高,而rituximab的使用增加了严重的COVID-19风险. 然而,COVID-19并没有显著影响移植后的免疫复原.
科学领域:
- 免疫学 免疫学 免疫学
- 传染性疾病 传染性疾病
- 血液学 血液学 血液学
背景情况:
- 有限的数据存在于严重急性呼吸系统综合征冠状病毒2 (SARS-CoV-2) 感染在血液造血干细胞移植 (HSCT) 后的早期免疫复合期间.
- 了解SARS-CoV-2对HSCT接受者的影响对于治疗移植后并发症至关重要.
研究的目的:
- 调查接受HSCT的患者中SARS-CoV-2感染的发病率和临床特征.
- 在HSCT接受者中识别SARS-CoV-2感染和严重COVID-19结局的风险因素.
- 评估SARS-CoV-2感染对HSCT后免疫复合的影响.
主要方法:
- 在2022年接受异性 (allo-HSCT) 或自身 (auto-HSCT) HSCT的患者 (n=117) 的回顾性分析.
- 数据收集包括SARS-CoV-2感染率,临床严重程度和从HSCT到感染的时间.
- 统计分析确定了风险因素,包括CD8+T细胞计数,氨酸抑制剂的使用,和Rituximab暴露.
主要成果:
- 在HSCT患者中,SARS-CoV-2感染率为59.8%,HSCT后的中位数间隔为4.8个月.
- 大多数感染是轻度 (41.4%) 或中度 (38.6%),20%为严重/危急;没有发生COVID-19相关死亡.
- 较低的CD8+T细胞计数和氨酸抑制剂的使用与SARS-CoV-2感染风险的增加有关.
- 瑞图西马布暴露显著增加了严重/危急COVID-19的概率 (P < .001),并且在多变量分析中与严重的COVID-19独立相关.
- COVID-19并没有显著影响免疫复原.
- 爱斯坦-巴尔病毒感染和rituximab的使用是严重疾病的潜在危险因素.
结论:
- 在HSCT后的早期免疫重建中,SARS-CoV-2感染很常见,通常具有轻度至中度的结果.
- 在HSCT接受者中,rituximab的使用是严重COVID-19的重要风险因素.
- 在HSCT后,COVID-19感染似乎不会阻碍免疫复原.
- 需要进一步的研究来阐明病毒感染,免疫抑制疗法和HSCT患者的结果之间的相互作用.
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