血造细胞移植后的细菌血流感染与移植后的基胺
Pedro Chorão1, Santiago de Cossio2, Paula Muñoz-Brell3
1Hematology Department, Hospital Universitari i Politècnic La Fe, València, Spain; Hematology Research Group, Institut d'Investigació Sanitària La Fe, València, Spain.
Transplantation and cellular therapy
|September 14, 2025
概括
细菌性血流感染 (BSI) 在血液细胞移植 (HCT) 后使用移植后环胺 (PTCy) 后很常见. 单独的捐赠者和急性移植与宿主疾病 (GVHD) 增加BSI风险,影响生存率.
科学领域:
- 血液学 血液学 血液学
- 传染性疾病 传染性疾病
- 移植免疫学 移植免疫学
背景情况:
- 细菌性血流感染 (BSI) 是血造细胞移植 (HCT) 后发病和死亡的重要原因.
- 在接受移植后循环胺 (PTCy) 预防的患者中,特别是在与HLA匹配的环境中,BSI的特征尚不清楚.
研究的目的:
- 为了评估细菌BSI的发病率,特征,风险因素和临床影响,在接受HCT和基于PTCy的GVHD预防治疗的患者中.
- 为了比较不同类型的捐赠者之间的BSI概况:匹配相关 (MSD),匹配无关 (MUD) 和哈普罗 (Haplo).
主要方法:
- 对456名接受HCT的患者进行了回顾性单中心分析.
- 数据收集包括细菌性BSI发作,捐赠者类型,GVHD预防 (PTCy) 和临床结果.
- 统计分析确定了BSI的独立风险因素,并评估了BSI相关的死亡率和整体存活率 (OS).
主要成果:
- 第一次BSI的累积发病率在2年后为28%,60%发生在HCT后30天内.
- 格拉姆阴性细菌占主导地位,特别是在移植后早期的哈普罗特异性HCT中;55%的格拉姆阴性和47%的格拉姆阳性分离物是多药耐药的.
- 哈普洛同一性捐赠者与早期BSI有关,而II-IV级急性GVHD在30天后的风险增加. 与BSI相关的死亡率为9%,晚期出现的BSI与更糟糕的生存状况相关.
结论:
- 细菌性BSI影响了超过四分之一的基于PTCy的HCT接受者,主要是移植后的早期,具有高的格兰阴性感染率.
- 哈普罗同一捐赠者和急性GVHD是BSI发展的独立风险因素.
- 晚发性BSI与整体存活率较低有关,这突显了需要警监测和管理的需要.
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