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Title: Lymphocyte Area Under the Curve as a Predictive Factor for Viral Infection after Allogenic Hematopoietic Stem Cell Transplantation
Authors: Watanabe, Mizuki
Kanda, Junya  kyouindb  KAKEN_id  orcid https://orcid.org/0000-0002-6704-3633 (unconfirmed)
Hishizawa, Masakatsu
Kondo, Tadakazu  kyouindb  KAKEN_id  orcid https://orcid.org/0000-0002-8959-6271 (unconfirmed)
Yamashita, Kouhei
Takaori-Kondo, Akifumi
Author's alias: 諫⽥, 淳也
菱澤, 方勝
近藤, 忠一
山下, 浩平
髙折, 晃史
Keywords: Lymphocyte AUC
HHV-6
CMV antigenemia
Viral reactivation
Immune reconstitution
Issue Date: Mar-2019
Publisher: Elsevier Inc.
Journal title: Biology of Blood and Marrow Transplantation
Volume: 25
Issue: 3
Start page: 587
End page: 593
Abstract: Viral infection is a serious complication that can greatly affect patient mortality and morbidity after allogenic hematopoietic stem cell transplantation (allo-HSCT). For the early identification of patients at high risk for viral infection, we evaluated the impact of lymphocyte area under the curve (AUC) value as a new predictive factor for early immune reconstitution after allo-HSCT against viral infection. This study included 286 patients who underwent their first allo-HSCT at Kyoto University Hospital between 2005 and 2017. Lymphocyte AUC from day 0 to day +15 was calculated in the analysis of human herpesvirus 6 (HHV-6), and lymphocyte AUC from day 0 to day +30 was calculated in the analysis of other viruses (cytomegalovirus [CMV], adenovirus, BK virus, JC virus, and varicella zoster virus). The risk factors for each viral reactivation/infection were assessed by multivariate analysis. The median age at transplantation was 51 years (range, 17 to 68 years). The median lymphocyte AUC was 63/μL (range, 0 to 5620/μL) at day +15 and 3880 (range, 0 to 118, 260/μL) at day +30. An increase in lymphocyte AUC was significantly associated with a high frequency of HHV-6 reactivation (P = .033) and a low frequency of CMV antigenemia (P = .014). No apparent association was found between lymphocyte AUC and reactivation/infection of other viruses. Aplastic anemia as a primary disease (hazard ratio [HR], 5.34; P < .001) and cord blood as a donor source (HR, 3.05; P = .006) were other risk factors for HHV-6 reactivation. Other risk factors for CMV antigenemia included the occurrence of acute graft-versus-host disease (HR 2.21; P < .001) and recipient age (HR 1.55; P = .017). Higher lymphocyte AUC at day +30 was significantly associated with low treatment-related mortality (HR, .47; P = .045). Lymphocyte AUC may be a good predictive factor for immune reconstitution against CMV reactivation. It also provides valuable information for predicting HHV-6 reactivation and treatment-related mortality.
Rights: © 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
The full-text file will be made open to the public on 1 March 2020 in accordance with publisher's 'Terms and Conditions for Self-Archiving'.
This is not the published version. Please cite only the published version. この論文は出版社版でありません。引用の際には出版社版をご確認ご利用ください。
URI: http://hdl.handle.net/2433/241617
DOI(Published Version): 10.1016/j.bbmt.2018.10.014
PubMed ID: 30359733
Appears in Collections:Journal Articles

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