Qamruddin A O, Oppenheim B A, Guiver M, Mutton K J, Chopra R
Public Health Laboratory, Withington Hospital, Manchester, UK.
Bone Marrow Transplant. 2001 Feb;27(3):301-6. doi: 10.1038/sj.bmt.1702778.
Potential risk factors for CMV infection and the use of quantitative CMV PCR screening to guide pre-emptive anti-CMV therapy were reviewed retrospectively in 32 allogeneic bone marrow transplant patients accrued over a 2-year period. Significant CMV PCR positivity (an indicator of CMV infection) developed in 34% of patients. When analysed by recipient CMV IgG serostatus, 69% of seropositive recipients developed significant CMV PCR positivity while none of the seronegative recipients did so (P = 0.00007). Considering only the seropositive recipients, 100% of those who received the low intensity campath-1H/fludarabine/melphalan 'mini-allograft' conditioning regimen developed significant CMV PCR positivity, while only 44% of those who had received cyclophosphamide/TBI did so (P = 0.0337). The mean time to first episode of significant CMV PCR positivity for those who had received campath/fludarabine/melphalan was 25 days while for those who had received cyclophosphamide/TBI, this was 66 days (P = 0.0372). For the first episode of significant CMV PCR positivity, the mean index and peak CMV PCR counts for those who had received campath/fludarabine/melphalan were 4.54 and 5.22 log copies/ml respectively, while for cyclophosphamide/TBI, the corresponding figures were 3.85 and 4.12 log copies/ml respectively (P = 0.2986 and P = 0.0472 for index and peak values). 85% of those who had significant CMV PCR positivity with the campath/fludarabine/melphalan regimen developed more than one such episode, while 50% of those receiving cyclophosphamide/TBI regimen did so (P = 0.491). Significant CMV PCR positivity was associated with symptoms in a proportion of patients (pyrexia 45%, cough 18%, rise in AST 72%). No patient developed overt CMV disease. CMV PCR is useful for guiding pre-emptive anti-CMV therapy and for monitoring response.
对32例在2年期间接受异基因骨髓移植的患者进行回顾性分析，以探讨巨细胞病毒（CMV）感染的潜在危险因素以及使用定量CMV聚合酶链反应（PCR）筛查来指导抢先抗CMV治疗的情况。34%的患者出现显著的CMV PCR阳性（CMV感染的指标）。按受者CMV IgG血清学状态分析，69%的血清阳性受者出现显著的CMV PCR阳性，而血清阴性受者无一出现（P = 0.00007）。仅考虑血清阳性受者，接受低强度campath-1H/氟达拉滨/美法仑“微型同种异体移植”预处理方案的患者中100%出现显著的CMV PCR阳性，而接受环磷酰胺/全身照射（TBI）的患者中只有44%出现（P = 0.0337）。接受campath/氟达拉滨/美法仑的患者首次出现显著CMV PCR阳性的平均时间为25天，而接受环磷酰胺/TBI的患者为66天（P = 0.0372）。对于首次出现显著CMV PCR阳性，接受campath/氟达拉滨/美法仑的患者的平均指数和峰值CMV PCR计数分别为4.54和5.22 log拷贝/ml，而对于环磷酰胺/TBI，相应数字分别为3.85和4.12 log拷贝/ml（指数和峰值的P值分别为0.2986和0.0472）。接受campath/氟达拉滨/美法仑方案且出现显著CMV PCR阳性的患者中85%出现不止一次此类发作，而接受环磷酰胺/TBI方案的患者中50%出现（P = 0.491）。部分患者的显著CMV PCR阳性与症状相关（发热45%，咳嗽18%，谷草转氨酶升高72%）。无患者发生明显的CMV疾病。CMV PCR对于指导抢先抗CMV治疗和监测反应有用。
