Clinical Analysis Of Epstein Barr Virus Infection In Patients With Thalassemia Major After Hematopoietic Stem Cell Transplantation

Objective:To analyze the incidence,risk factors and prognosis of Epstein Barr virus(EBV)infection in patients with thalassemia major after Allogeneic hematopoitic stem cell transplantation(Allo-HSCT),so as to provide effective prevention and treatment strategies for clinical diagnosis and treatment.Methods:The clinical data of 446 patients with thalassemia major who underwent hematopoietic stem cell transplantation in our hospital from January2015 to September 2020 were retrospectively analyzed.The factors of patients’sex,age,splenectomy,serum ferritin(SF),human leukocyte antigen(HLA)matching type,donor source,gender of donor and recipient,stem cell including cord blood,anti-thymocyte immunoglobulin(ATG)dose,ABO blood group compatibility degree of recipient,prevention of graft-versus-host disease(GVHD),CD34+infusion quantity,Cytomegalovirus(CMV)infection,hemorrhagic cystitis,Veno-occlusive disease(VOD),and acute and chronic GVHD were studied.To analyze the incidence,risk factors and prognosis of EBV infection in patients with severe thalassemia after hematopoietic stem cell transplantation.Results:1.The median follow-up time of 446 patients with thalassemia major was 31(1～72)months,68 cases developed EBV infection,the incidence rate was 15.2%(68/446),of which the simple EBV DNA-emia was 9.64%(43/446),and the overall incidence of probable or proven PTLD was 2.91%(13/446).The overall incidence of EBV-related diseases was 2.69%.The cumulative incidence of EB virus infection within 100 days after transplantation was 70.1%,including 41 males and 27 females.The median viral load of initial infection was8.49×10~2(4.13×10~2～4.7×10~4)copies/ml.The median time of initial infection was+63(14～567)days after transplantation,and the median age was 6(2～16)years old.2.The overall survival rate of EB virus infection after transplantation was89.7%(61/68),and the overall survival rate of patients without EB virus infection was 96.6%(365/378).There was significant difference between the two groups(P<0.05).The survival rate of patients without EB virus infection after transplantation was higher.3.Univariate analysis showed that the risk factors of EBV infection after transplantation were whether the stem cell source contained umbilical cord blood,whether the blood type of donor and recipient matched,CMV infection after transplantation and c GVHD.Multivariate analysis showed that the stem cell source contained umbilical cord blood,blood type mismatch between donors and recipients,CMV infection after transplantation and c GVHD were independent risk factors for EB virus infection after hematopoietic stem cell transplantation.Conclusion:1.ABO blood group mismatch,stem cell source including umbilical cord blood transplantation,CMV infection after allo-HSCT and c GVHD are independent risk factors of EB virus infection after hematopoietic stem cell transplantation in patients with thalassemia major.2.EB virus infection after transplantation affects the long-term survival of patients.Close monitoring and early intervention are effective measures to improve the prognosis.