Abstract：
Cytomegalovirus (CMV) infection poses significant risks in allogeneic haematopoietic stem cell transplant (allo-HSCT) recipients. Despite advances in antiviral therapies, issues such as drug resistance, side effects, and inadequate immune reconstitution remain. This systematic review and meta-analysis aim to evaluate the efficacy and safety of adoptive cell therapy (ATC) in managing CMV infections in allo-HSCT recipients. Adhering to preferred reporting items for systematic reviews and meta-analyses guidelines, we conducted a comprehensive database search through July 2023. A systematic review and meta-analysis were conducted on studies involving HSCT patients with CMV infections treated with ATC. The primary outcome was the response rate to ATC, and secondary outcomes included adverse events associated with ATC. The Freeman-Tukey transformation was applied for analysis. In the meta-analysis of 40 studies involving 953 participants, ATC achieved an overall integrated response rate of 90.16%, with a complete response of 82.59% and a partial response of 22.95%. ATC source, HLA matching, steroid intake, and age group markedly influenced response rates. Donor-derived T-cell treatments exhibited a higher response rate (93.66%) compared to third-party sources (88.94%). HLA-matched patients demonstrated a response rate of 92.90%, while mismatched patients had a lower rate. Children showed a response rate of 83.40%, while adults had a notably higher rate of 98.46%. Adverse events were minimal, with graft-versus-host disease occurring in 24.32% of patients. ATC shows promising response rates in treating CMV infections post-HSCT, with an acceptable safety profile. However, to establish its efficacy conclusively and compare it with other antiviral treatments, randomised controlled trials are essential. Further research should prioritise such trials over observational and one-arm studies to provide robust evidence for clinical decision-making.
摘要：
巨细胞病毒（CMV）感染在异基因造血干细胞移植（allo-HSCT）受者中构成重大风险。尽管抗病毒治疗取得了进展，诸如抗药性等问题，副作用,免疫重建不足仍然存在。本系统综述和荟萃分析旨在评估过继细胞疗法（ATC）在同种异体HSCT受者中管理CMV感染的有效性和安全性。坚持系统评价和荟萃分析指南的首选报告项目，到2023年7月，我们进行了全面的数据库搜索。对涉及接受ATC治疗的CMV感染的HSCT患者的研究进行了系统评价和荟萃分析。主要结果是ATC的反应率，次要结局包括与ATC相关的不良事件.应用Freeman-Tukey变换进行分析。在涉及953名参与者的40项研究的荟萃分析中，ATC实现了90.16%的整体综合反应率，完全缓解82.59%，部分缓解22.95%。ATC源,HLA匹配,类固醇摄入量，和年龄组显着影响反应率。与第三方来源(88.94%)相比,供体来源的T细胞治疗表现出更高的应答率(93.66%)。HLA匹配的患者表现出92.90%的反应率，而错配患者的发病率较低。儿童的反应率为83.40%，而成年人的发病率明显较高，为98.46%。不良事件很少，24.32%的患者发生移植物抗宿主病。ATC在HSCT后治疗CMV感染方面显示出有希望的反应率，具有可接受的安全性。然而,确定其疗效，并与其他抗病毒治疗进行比较，随机对照试验至关重要.进一步的研究应将此类试验优先于观察性和单臂研究，为临床决策提供有力的证据。
