肿瘤细胞治疗研究
英文原题：Incidence and risk factors of Epstein-Barr virus infection and post-transplant lymphoproliferative disorder in paediatric haploidentical allogeneic hematopoietic stem cell transplantation.
我们回顾性分析了448例在北京大学人民医院接受基于抗胸腺细胞球蛋白（ATG）的单倍体HSCT并接受来特莫韦预防的儿科患者（18岁）（2022年10月至2025年10月），采用1：3倾向评分匹配设计。
EBV再激活是单倍型造血干细胞移植（haplo-HSCT）后的严重并发症，有时会进展为移植后淋巴增殖性疾病（PTLD）。我们采用1:3倾向性评分匹配设计，回顾性分析了在北京大学人民医院接受基于抗胸腺细胞球蛋白（ATG）的haplo-HSCT并接受letermovir预防的448例儿科患者（<18岁）（2022年10月—2025年10月）。EBV血症和PTLD的发生率分别为12.4%和4.9%。多因素分析显示，既往接受嵌合抗原受体（CAR）T细胞治疗（风险比（HR）= 2.040，95% CI 1.061-3.920；p = 0.033）以及EBV血症前出现巨细胞病毒（CMV）血症（HR = 6.075，95% CI 3.377-10.928；p < 0.001）是EBV血症的危险因素。采用基于全身照射（TBI）的预处理方案时PTLD风险更高（HR = 1.917，95% CI 0.980-3.750；p = 0.050）。两组间总生存无差异（EBV阳性：92.9% vs. EBV阴性：96.4%；p = 0.10），但EBV感染患者的无事件生存较差（86.6% vs. 94.6%；p = 0.004）。EBV血症队列中慢性移植物抗宿主病（17.0% vs. 6.5%；p < 0.001）和移植相关死亡（7.1% vs. 2.1%；p = 0.005）显著更高。EBV再激活和PTLD构成严重挑战，其危险因素包括TBI预处理、既往CAR-T治疗以及EBV血症前出现CMV血症。抢先性细胞毒性T淋巴细胞治疗可能使高危患者获益。
Epstein-Barr virus (EBV) reactivation after haploidentical stem cell transplant (haplo-HSCT) is a serious complication, which sometimes progresses to post-transplant lymphoproliferative disorder (PTLD). We retrospectively analyzed 448 pediatric patients ( 18 years) undergoing anti-thymocyte globulin (ATG)-based haplo-HSCT with letermovir prophylaxis at Peking University People's Hospital (Oct 2022-Oct 2025), using a 1:3 propensity score-matched design. EBV viremia and PTLD incidences were 12.4% and 4.9%. Multivariate analysis showed prior Chimeric Antigen Receptor (CAR) T-cell therapy (Hazard ratio (HR) = 2.040, 95% CI 1.061-3.920; p = 0.033) and Cytomegalovirus (CMV) viremia preceding EBV viremia (HR = 6.075, 95% CI 3.377-10.928; p < 0.001) were risk factors for EBV viremia. The PTLD risk was higher with a total body irradiation (TBI)-based conditioning regimen (HR = 1.917, 95% CI 0.980-3.750; p = 0.050). Overall survival did not differ between groups (EBV + : 92.9% vs. EBV-: 96.4%; p = 0.10), but event-free survival was inferior in EBV-infected patients (86.6% vs. 94.6%; p = 0.004). Chronic graft-versus-host disease (17.0% vs. 6.5%; p < 0.001) and transplant-related mortality (7.1% vs. 2.1%; p = 0.005) were significantly higher in the EBV viremia cohort. EBV reactivation and PTLD pose serious challenges, and risk factors include TBI conditioning, prior CAR-T therapy, and CMV viremia preceding EBV viremia. Preemptive cytotoxic T lymphocyte therapy may benefit high-risk patients.
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