الفهرس 
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Abstract
There is a high prevalence of cytomegalovirus (CMV) seropositivity in developing countries. An apparent risk of CMV reactivation increases following hematopoeitic stem cell transplantation. Despite advances in immunosuppressive and antiviral therapy, acute graft-versus-host disease and post cytomegalovirus reactivation remain major complications following allogeneic HSCT transplantation. With effective surveillance and study the effect some factors on CMV reactivation, timely treatment using anti-viral therapy, morbidity and mortality associated with CMV reactivation can be reduced.It is not clear the role of humoral immunity in regulating replication of CMV. The most significant factor in regulating CMV replication is T cell mediated cellular immunity.CMV-specific CD8+ CTL response reconstitution after hematopoietic cell transplantation correlates with CMV defense and enhanced outcome of CMV disease. Our retrospective study designed to evaluate thecorrelation between Cytomegalovirus reactivation in allogeneic bone marrow transplantation patient’s complicated with acute graft-versus-host disease and immunological status. I prospectively analysed25 patients with Serostatus positive of CMV IgG antibodies who underwent allogeneic hematopoietic stem cell transplantation at two Bone Marrow Transplantation centers in Egypt (Nasser Institute Bone Marrow Transplantation center, Nasser Institute for Research and Treatment and Bone Marrow Transplantation Unit and Tanta University International, Tanta University )from November 2016 to June 2017. The main findings can be summarized as following: -There were no difference in the clinical features between the two groups (CMV reactivation and non reactivation), including age and sex of patient and donors, clinical diagnosis of patients, and viral screening of donors. -No difference were found regarding the matching in sex and blood groups in CMV reactivating and not reactivating groups. -In my study, the patient male percentage was 57.1% in CMV reactivation group with the most common pre-transplantation diagnosis was FA,CML and βTM. All donors in reactivation group (100 %) were positive for CMV IgG ab. These group had 42.9% matching donors in sex and blood groups. While the stem cell source was 92.9% peripheral blood source with median dose 7.0 cells ×106 ∕ kg. - A significant differences (P≤0.05) between the two groups (CMV reactivation and non reactivation)as regards to patient CMV Ab (IgG) titer and donor CMV Ab (IgG) titer. - A significant statistical differences (P≤ 0.05) as regards to mortality between the two groups(CMV reactivation and non reactivation). - In group without CMV reactivation, just two cases had aGVHD from those, one case were grade I and the other one were grade II. In other group with CMV reactivation 8 cases from 14 cases had aGVHD from those 3 cases were grade I-II and 8 cases were grade II-IV. A significant difference (P≥0.05) between the two groups as regards to incidence and grade (II-IV) of aGVHD, while no significant differences between the two groups as regard to grade I-II of aGVHD. -No difference were observed in the day of neutrophil and platelet engraftment in CMV reactivating and not reactivating groups. -The percentage of reactivated cases was 40 % and 80 % for groups without aGVHD and with aGVHD complication respectively, while not reactivated percentage was 60 % and 20 % for two group respectively with significant difference (P≤0.05) between both groups. -No difference were observed in CMV reactivation, donor ∕ recipient CMV status and first CMV manifestations with aGVHD complication groups. While, a significant difference were found as regards to CMV PCR titer and duration of lymphopenia (p=0.007&P=0.011; respectively). -The degree of kinships between patient and donors, CMV IgG status of donors, conditioning regimen, oral mucositis and secondary infection were not different in two groups CMV reactivated and not reactivated. The comparison between the two studied groups according to immunological status of donor and patient before transplantation and their effect on CMV reactivation show that: 1-Significant difference in CMV reactivated and not reactivated groups as regard absolute lymphocytes (p=0.025&P=0.001; respectively).In CMV not reactivated group, absolute lymphocytes of donor and patient before transplantation were significant only with the first month after transplantation, while in reactivated group, there was a significantdifferences between the donor and the patient after the transplantation either in 1st or 3rd month after transplantation. 2-Absolute CD3 of donor and patient before transplantation were observed in two groups reactivated and not reactivated as significant withbaseline, and in 1st or 3rd month post-transplantation measurements (P=0.028& p=0.003, respectively). While, absolute CD3 of donor and recipient before transplantationwere significant with 1stmonth only in reactivated and not reactivated groups, 3-There were highlysignificant difference as regard to the absolute count of CD4 between the donor, the baseline, and in 1st or 3rd month posttransplantationin two groups (reactivated & not reactivated P≤0.01 ). The donorandrecipient before transplantation weresignificant with the patient after the transplantation in 1st and 3rd month in two groups. 4- On contrast, my result revealed nosignificant differenceas regards to the absolute count of CD8 between the donor, the recipient and in 1st or 3rd month post-transplantation measurements in two groups (reactivated & not reactivated). 5-The statistical analysis revealed a highly significant variations as regards to CD4 ∕ CD8 ratio between the donor, the baseline, and in 1st or 3rd month post-transplantation in reactivated and not reactivated groups (P=0.006&P≤0.01, respectively). Also,there were a significantdifferences between donor, recipientbaseline and the patient after the transplantation in the 1st and 3rd month after transplantation in two groups exceptrecipientbaseline and3rd month in not reactivated group. - Comparison between the two studied groups according to immunological status of donor and patient before transplantation and their effect on aGVHD complication showed show that: 1- No difference were found regarding the conditioning regimens and two groups with aGVHD complication and without aGVHD complication. 2- Significant variation between absolute lymphocyte count of the donor, the baseline, and in 1st or 3rd month post-transplantation (P=0.007 &P<0.001, respectively).In the 1st and 3rdmonth post-transplantation measurements, there were a significant differences between the donor and the recipientbaseline with patient after the transplantation in two groups. 3-Also, significant variation between absolute CD3 count of the donor, the baseline, and in 1st or 3rd month post-transplantation (P=0.013 &P=0.006, respectively).In the 1stmonth post-transplantation measurements, there were a significant differences between the donor and the recipientbaseline with patient after the transplantation, while no significant difference in 3rd months in two groups. 4- Significant variation between absolute CD4 count of the donor, the baseline, and in 1st or 3rd month post-transplantation (P=0.007 &P<0.001, respectively).In the 1st and 3rdmonth post-transplantation measurements, there were a significant differences between the donor and the recipientbaseline with patient after the transplantation in two groups. 5- On contrast, my result revealed no significant differences regards to the absolute count of CD8 between the donor, the recipient and in 1st or 3rd month post-transplantation measurements in two groups (aGVHD complication and without complication). 6-Also, the significant variation between absolute CD4 ∕ CD8 ratio of the donor, the baseline, and in 1st or 3rd month post-transplantation (P=0.002 &P<0.001, respectively).In the 1st and 3rdmonth post-transplantation measurements, there were a significant differences between the donor and the recipientbaseline with patient after the transplantation in two groups. -My result of the comparison between the studied patients according to immunological statusof donor and patient before transplantation and their effect on mortality showed show that: 1-highly significant variations (P≤0.01) between absolute lymphocyte count of the donor, the baseline, and in 1st or 3rd month posttransplantation in alive group, while non significantvariations(P˃0.05) in dead group. 2-highly significant variations between absolute CD3 count of the donor, the baseline, and in 1st or 3rd month post-transplantation in alive and dead groups(P≤0.01&P= 0.040, respectively).In the 1stmonth posttransplantation measurements, there were a significant differences between the donor and the recipientbaseline with patient after the transplantation, while non significant differences in 3rd month,in the two groups. 3- highly significant variations between absolute CD4count of the donor, the baseline, and in 1st or 3rd month post-transplantation in alive and dead groups (P≤0.01&P= 0.036, respectively).In the 1st and 3rdmonth posttransplantation measurements, there were a significant differences between the donor and the recipientbaseline with patient after the transplantation in alive group, while, in dead group 1st month only significant differenceswas observed betweenrecipientbaseline. 4- On contrast, my result revealed no significant difference as regards to the absolute count of CD8 between the donor, the recipient baseline and 1st or 3rd month post-transplantation measurements in two groups (alive and dead groups). 5- highly significant variations between absolute CD4∕CD8 ratioof the donor, the baseline, and in 1st or 3rd month post-transplantation in alive and dead groups (P≤0.01&P= 0.036, respectively).In the 1st and 3rdmonth post-transplantation measurements, there were a significant differences between the donor and the recipientbaseline with patient after the transplantation in alive group, while, in dead group 1st month only significant differences was observed betweenrecipientbaseline. -CMV IgG titer in the donorand the patients together with the age of the donor and acute graft-versus host disease grade II- IV were a significant predictors of reactivation using a univariate regression mode, while using multivariate analysis model, non of the mentioned parameters was significant. -The Kaplan-Meier survival curve for overall survival with CMV reactivation and copies in patients with CMV reactivation showsno significant statistical differences between the two groupsas regards to survival.