Background/Objectives:This study evaluated infectious complications and immune reconstitution in 253 adults undergoing peripheral blood allogeneic hematopoietic cell transplantation (allo-HCT) with post-transplant cyclophosphamide (PTCY)-based GVHD prophylaxis.Methods:Patients received grafts from HLA-matched donors (47.4%), mismatched unrelated donors (MMUD, 33.2%), or haploidentical donors (19.4%).Results:The estimated 2-year non-relapse mortality (NRM) was 11.8%, 26.4%, and 22.4%, respectively (p= 0.0528). The cumulative incidence (Cum.Inc) of acute and chronic GVHD, immunosuppression duration, and post-transplant outcomes were similar across donor types. The day +30 Cum.Inc of bacterial bloodstream infections (BSI) tended to be higher in HLA-matched transplants (49.2%,p= 0.073), while HHV-6 reactivation showed a trend toward higher frequency in haploidentical transplants (22.4%,p= 0.068). Cytomegalovirus (CMV) reactivation occurred between days +30 and +100, with the highest Cum.Inc in MMUD (59.5%,p= 0.033). BK virus-associated hemorrhagic cystitis showed a trend toward higher incidence in MMUD (22.3%,p= 0.056). Respiratory and fungal infections were most frequent in the first 100 days, with comparable rates across donor types. By day +180, most patients achieved immune reconstitution, with normalization of CD4+ T cells, CD8+ T cells, and IgG levels, independent of donor type.Conclusions:Patients undergoing allo-HCT with PTCY-based prophylaxis experience a high infectious density rate early post-transplant, which decreases after 6 months as immune reconstitution progresses, regardless of donor type.
背景/目的：本研究评估了253例接受外周血异基因造血细胞移植（allo-HCT）并采用基于移植后环磷酰胺（PTCY）的移植物抗宿主病（GVHD）预防方案的成人患者的感染并发症及免疫重建情况。 方法：患者移植物来源于HLA相合供者（47.4%）、不相合无关供者（MMUD，33.2%）或单倍体相合供者（19.4%）。 结果：估计的2年非复发死亡率（NRM）分别为11.8%、26.4%和22.4%（p=0.0528）。急性和慢性GVHD的累积发生率（Cum.Inc）、免疫抑制持续时间以及移植后结局在不同供者类型间相似。HLA相合移植患者在第+30天时细菌性血流感染（BSI）的累积发生率有较高趋势（49.2%，p=0.073），而人疱疹病毒6型（HHV-6）再激活在单倍体相合移植中显示出更高频率的趋势（22.4%，p=0.068）。巨细胞病毒（CMV）再激活发生在移植后第+30至+100天之间，其中MMUD组的累积发生率最高（59.5%，p=0.033）。BK病毒相关出血性膀胱炎在MMUD组中显示出较高发生率的趋势（22.3%，p=0.056）。呼吸道感染和真菌感染在移植后前100天内最为常见，且在不同供者类型间发生率相当。至移植后第+180天，大多数患者实现了免疫重建，CD4+ T细胞、CD8+ T细胞和IgG水平恢复正常，且与供者类型无关。 结论：接受基于PTCY预防方案的allo-HCT患者，在移植后早期经历较高的感染密度，但随着免疫重建的进展，无论供者类型如何，感染率在6个月后均下降。
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