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血细胞移植后爱斯坦-巴尔病毒再激活的预防性利图西马布:对所有人来说都是必要的吗?

Anna Beatriz Coelho de Souza¹, Anderson João Simione¹, Ana Cláudia Ferrari Dos Santos¹

¹HCT Program, Fundação Hospital Amaral Carvalho, Jaú, Brazil.

Transplant infectious disease : an official journal of the Transplantation Society

|November 3, 2025

概括

降低免疫抑制 (IS) 是一种安全和有效的第一方法,用于在异种HCT后对爱斯坦-巴尔病毒 (EBV) 重活化. 这一策略显著降低了在EBV重新激活管理中需要Rituximab的需求.

科学领域:

血液学血液学血液学
免疫学免疫学免疫学
传染性疾病传染性疾病

背景情况:

爱斯坦-巴尔病毒 (EBV) 再激活是全源造血干细胞移植 (HCT) 接受者的风险,可能导致移植后淋巴增殖障碍 (PTLD) 或末端器官疾病.
目前的指导方针建议使用PCR和先发性rituximab监测EBV活性,尽管证据有限,并且对rituximab的副作用,如长时间的B细胞枯竭和低血糖球蛋白血症,存在担忧.

研究的目的:

评估降低免疫抑制 (IS) 的安全性和有效性,作为管理EBV重新激活在异种HCT接受者的首要策略.
为了确定Rituximab的使用率,当IS减少是初始治疗方法时.

主要方法:

一个回顾性,单中心研究,涉及328名异性HCT受体.
评估了经历了EBV重新激活的患者的结果,并将IS减少作为第一线治疗.
利图西马布被保留给那些对IS减少无反应的患者或那些患有EBV末端器官疾病或PTLD的患者.

主要成果:

在54.6%的患者 (178/328) 中发生了EBV重新激活.
只有6.7%的患者 (12/178) 需要Rituximab.
没有观察到PTLD病例;EBV脑炎发生在2.2%的重新激活患者中.
EBV的再激活与慢性GVHD相关,但没有影响非复发性死亡率或整体存活率.

结论:

降低IS是一种安全有效的初始治疗EBV再激活在HCT接受者与EBVDNAemia上升.
这种方法显著减少了对rituximab的需求,从而可能减轻了与之相关的风险.

关键词:

这是EBV的EBV.在HCT中,HCT是HCT.这是一个 PTLD.末端器官疾病的疾病免疫抑制是一种免疫抑制.这就是Rituximab.

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