title: [Clinical outcomes of allogeneic hematopoietic stem cell transplantation patients with co-activation of cytomegalovirus and Epstein-Barr virus].
abstract: OBJECTIVE
  To evaluate the impact of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) co-activation on the prognosis of allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients.
  
  
  METHODS
  We retrospectively analyzed 330 consecutive allo-HSCT patients at First Affiliated Hospital of Soochow University from December 2011 to August 2013. CMV and EBV DNA were regularly monitored by quantitative polymerase chain reaction (PCR) from the engraftment of granuloCyte within one year after transplantation. The incidences of viremia and clinical outcomes were analyzed by χ(2) test and Kaplan-Meier analysis.
  
  
  RESULTS
  After a median follow-up period of 16 (7-25) months, a total of 113 (34.2%) patients were identified with CMV viremia (CMV+) alone, 82 (24.8%) with EBV viremia (EBV+) alone and 32 (9.7%) with CMV and EBV co-activation (CMV/EBV+). The proportion of patients undergoing HLA mismatched transplantation and ones with acute graft-versus-host disease (aGVHD) in CMV/EBV+ group was significantly higher than CMV+ group or EBV+ group (78.1% (25/32) vs 58.5% (48/82) or 50.4% (57/113), P = 0.047,0.008; 56.3% (18/32) vs 32.9% (27/82) or 34.5% (39/113) , P = 0.022, 0.026) . The incidence of post-transplant lymphoproliferative disorder (PTLD) was similar to EBV+ group (12.5% (4/32) vs 11.0% (9/82) , P = 0.802) and so did the incidence of CMV disease when compared with CMV+ group (9.4% (3/32) vs 7.1% (8/113) , P = 0.665). The 2-year overall survival (OS) of CMV+, EBV+ and CMV/EBV+ groups was 68.7%, 61.5% and 62.4% respectively. And no significant difference existed between CMV/EBV+ and the other two groups (P = 0.598, 0.717). However, the 6-month non-relapse mortality (NRM) of CMV/EBV+ group was significantly higher than that of CMV+ or EBV+ group (18.7% vs 8.9%, P = 0.036; 18.7% vs 8.1%, P = 0.032).
  
  
  CONCLUSIONS
  HLA mismatch transplants and aGVHD are frequent in CMV and EBV co-activation group. When compared with EBV+ or CMV+ patients, the CMV/EBV+ patients have similar incidence of PTLD or CMV disease and 2-year OS.However, the 6-month NRM is significantly higher in CMV/EBV+ group. It suggests that CMV and EBV co-activation is a risk factor for early mortality of allo-HSCT patients.
authors.affiliation: Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, Key Laboratory of Thrombosis and Hemostasis under Ministry of Health, Suzhou 215006, China.
authors.forename: Tiemei
authors.initials: T
authors.lastname: Song
authors.forename: Guanghua
authors.initials: G
authors.lastname: Chen
authors.forename: Xiang
authors.initials: X
authors.lastname: Zhang
authors.forename: Yang
authors.initials: Y
authors.lastname: Xu
authors.forename: Jia
authors.initials: J
authors.lastname: Chen
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.forename: Linlin
authors.initials: L
authors.lastname: Ye
authors.forename: Jing
authors.initials: J
authors.lastname: Xu
authors.affiliation: Email: wudepei@medmail.com.cn.
authors.forename: Depei
authors.initials: D
authors.lastname: Wu
authors.affiliation: School of Biology and Basic Medical Sciences of Soochow University, Suzhou 215124, China. Email: mjc@suda.edu.cn.
authors.forename: Jingcheng
authors.initials: J
authors.lastname: Miao
mesh_terms: D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections; D020031:Epstein-Barr Virus Infections; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation; D004854:Herpesvirus 4, Human; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous; D014766:Viremia; D014775:Virus Activation