Konoplev S, Champlin R E, Giralt S, Ueno N T, Khouri I, Raad I, Rolston K, Jacobson K, Tarrand J, Luna M, Nguyen Q, Whimbey E
Department of Blood and Marrow Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Bone Marrow Transplant. 2001 Apr;27(8):877-81. doi: 10.1038/sj.bmt.1702877.
CMV pneumonia is a major cause of morbidity and mortality among allogeneic BMT recipients. To assess the frequency, timing, risk factors and response to therapy of CMV pneumonia among autologous BMT recipients, we reviewed our experience with 795 patients. Sixteen (2%) patients were diagnosed with CMV pneumonia. The frequency was higher among patients who were seropositive than those who were seronegative (3.3% vs 0%, P = 0.008). Among seropositive patients, the frequency was higher among patients with hematological malignancies than patients with solid tumors (5.0 % vs 1.0%, P = 0.019). Eleven cases occurred <30 days, and five cases occurred >100 days post transplant. The overall CMV pneumonia-related mortality rate was 31%. Seven (78%) of nine patients treated with ganciclovir and IVIG prior to respiratory failure survived; neither of two patients treated after respiratory failure survived. Four of five (80%) untreated patients survived. In conclusion, CMV is a not infrequent cause of pneumonia among autologous BMT recipients. Risk factors include CMV seropositivity and an underlying hematological malignancy. A favorable response hinges on the prompt initiation of therapy. The survival of 25% of the patients without antiviral therapy suggests that the isolation of CMV from a BAL specimen occasionally reflects oropharyngeal contamination or that CMV pneumonia may sometimes be self-limited in more immunocompetent autologous BMT recipients.
巨细胞病毒肺炎是异基因骨髓移植受者发病和死亡的主要原因。为评估自体骨髓移植受者中巨细胞病毒肺炎的发生频率、时间、危险因素及对治疗的反应，我们回顾了795例患者的情况。16例（2%）患者被诊断为巨细胞病毒肺炎。血清学阳性患者的发生率高于血清学阴性患者（3.3%对0%，P = 0.008）。在血清学阳性患者中，血液系统恶性肿瘤患者的发生率高于实体瘤患者（5.0%对1.0%，P = 0.019）。11例发生在移植后<30天，5例发生在移植后>100天。巨细胞病毒肺炎相关的总体死亡率为31%。9例在呼吸衰竭前接受更昔洛韦和静脉注射免疫球蛋白治疗的患者中有7例（78%）存活；2例在呼吸衰竭后接受治疗的患者均未存活。5例未治疗患者中有4例（80%）存活。总之，巨细胞病毒是自体骨髓移植受者肺炎的常见病因。危险因素包括巨细胞病毒血清学阳性和潜在的血液系统恶性肿瘤。良好的反应取决于治疗的及时启动。25%未接受抗病毒治疗的患者存活表明，从支气管肺泡灌洗标本中分离出巨细胞病毒有时反映口咽污染，或者在免疫功能较强的自体骨髓移植受者中，巨细胞病毒肺炎有时可能是自限性的。
