Clinical Analysis Of Epstein Barr Virus Infection After Allogenic Hematopoietic Stem Cell Transplantation In 143 Patients With Hematopathy

Background:Nowadays,allogeneic hematopoietic stem cell transplantation(allo-HSCT)is an effective treatment for various high risk malignant hematological diseases.Epstein-barr virus(EBV)is a Y herpesvirus,infecting 90%of adults in the world.Initially patients infected with the EBV were asymptomatic and established life-long immunity with a low copy in memory B cell.In individuals with perfect immune function,the perfect and strong CD4+/CD8+T cells subsets control the amplification of EBV infections by recognizing the viral epitopes on the surface of the B cell groups.Allogeneic hematopoietic stem cell transplantation inhibits the human immune system from preventing transplantation disease versus host disease(GVHD)and activates the EVB that lurking in B cells.EVB infections is one of the common complications after allogeneic hematopoietic stem cell transplantation.It can cause a series of EVB-related clinical diseases,the most serious diseases is EVB-lymphoproliferative disease(EVB-PTLD).Its mortality rate is as high as 70%-90%,which seriously affects the postoperative recovery and survival of transplant patients.Objective:The risk factors of EBV infections after allogeneic hematopoietic stem cell transplanttation were analyzed retrospectively.And the treatment and prevention of EBV infections were discussed in order to reduce the morbidity of complications related EBV,and to improve the overall survival of malignant hematological diseases.Methods:A retrospective analysis of 143 patients with allogeneic hematopoietic stem cell transplantation from March 2013 to March 2018 was performed in our hospital.There were 82 males and 61 females with a median age of 30(2-58)years,including severe aplastic anemia(sAA),acute lymphoblastic leukemia(ALL),acute myeloid leukemia(AML),chronic myeloid leukemia(CML),myelodysplastic syndrome(MDS)and other hematological diseases.Among them,74 cases were infected by EBV.With SPSS statistical software,to analyse the relation between Sex,age,complete remission or not,risk stratification,conditioning regime,stem cell source,the treatment of antithymocyte immunoglobulin,the infusion of mesenchymal stromal cell,prophylactic antivirus,acute GVHD,chronic GVHD and EBV infections after allogeneic hematopoietic stem cells transplantation.Results:1.74 cases of EBV were found in 143 patients.The overall EBV infection rate was 51.7%after allogeneic hematopoietic stem cells transplantation.Among 74 patients,there are 27 cases with EBV DNA≥1.0×10^5 copies/ml.And one of them was as high as 1.0 ×10^8 copies/ml,suspected lymphoproliferative disease after transplantation,and eventually died.2.By x2 analysis,it showed that HLA mismatched,the treatment of antithymocyte immunoglobulin(ATG)or ATG-F,stem cells from different sources,adding mesenchymal stem cells,chronic graft-versus-host disease was associated with EBV infection after allogeneic hematopoietic stem cell transplantation(P<0.05).Binary logistics multivariate analysis was performed.The results showed that ATG was a risk factor for EBV infection after allogeneic hematopoietic stem cell transplantation.Conclusion:1.EBV infection is a common complication after allo-HSCT,and PTLD is the most serious complication of EBV infection.Nowadays,there are no effective drugs.So,early diagnosis and preemptive treatment of Rituximab can improve prognosis,reduce mortality,prolong the overall survival of patients,and improve the quality of life of patients.2.The use of ATG was a risk factor for EBV infection after allogeneic hematopoietic stem cell transplantation.3.At present,there is no effective drugs to treat the EBV infection and PTLD.So preventing reactivation of EBV in various high risk malignant hematological diseases is to reduce EBV infection after allo-HSCT.For example,Rituximab is recommended in first line.But,it will increase the risk of other infections,so it is important to choose the right time and weigh the advantages and disadvantages,when you choose it.4.There is currently no evidences of early prophylactic antiviral therapy to reduce the incidence of EBV after allo-HSCT.However,prophylactic antiviral therapy is still widely used in clinic,based on reducing the incidence of varicella-zoster virus infection and increasing the success rate of allo-HSCT.