Vusirikala M, Wolff S N, Stein R S, Brandt S J, Morgan D S, Greer J P, Schuening F G, Dummer J S, Goodman S A
Division of Hematology and Oncology, Department of Medicine, Vanderbilt University School of Medicine and VA Medical Center, Nashville, TN 37212, USA.
Bone Marrow Transplant. 2001 Aug;28(3):265-70. doi: 10.1038/sj.bmt.1703129.
A retrospective single center study was performed to evaluate the safety and efficacy of valacyclovir for prevention of cytomegalovirus (CMV) infection (reactivation) after allogeneic stem cell transplantation (SCT). We compared a group of 31 patients at risk for CMV reactivation (donor, recipient or both seropositive for CMV) who received valacyclovir at an oral dose of 1 g three times a day for CMV prophylaxis with a matched cohort of 31 patients who did not receive the drug or any other form of CMV prophylaxis. Valacyclovir was used as primary prophylaxis in 12 patients and as secondary prophylaxis (after a prior CMV reactivation was effectively treated with either ganciclovir or foscarnet and without CMV antigenemia at the start of valacyclovir) in the remaining 19 patients. The two treatment groups were well matched for the donor-recipient CMV serological status and other pre-transplant characteristics. CMV reactivation was detected by blood antigenemia testing using a commercially available immunofluorescence assay for CMV lower matrix protein pp65 in circulating leukocytes. For primary prophylaxis, 3/12 patients who received valacyclovir reactivated CMV compared to 24/31 patients in the control group (P < 0.001). For secondary prophylaxis, 5/19 valacyclovir patients reactivated compared to 16/24 control patients (P < 0.05). Valacyclovir was well tolerated except for infrequent and mild gastrointestinal side-effects. There was no difference in the incidence of CMV disease in the two groups. Prophylaxis with valacyclovir appears to be safe and efficacious in preventing both primary and secondary CMV reactivation in at-risk patients after allogeneic SCT. Larger prospective randomized studies will be required to confirm these observations.
进行了一项回顾性单中心研究，以评估伐昔洛韦预防异基因干细胞移植（SCT）后巨细胞病毒（CMV）感染（再激活）的安全性和有效性。我们将一组31例有CMV再激活风险的患者（供体、受体或两者CMV血清学阳性）与另一组31例未接受该药物或任何其他形式CMV预防的匹配患者进行了比较，前一组患者接受伐昔洛韦口服，剂量为每日3次，每次1 g，用于CMV预防。12例患者使用伐昔洛韦进行一级预防，其余19例患者使用伐昔洛韦进行二级预防（在先前的CMV再激活用更昔洛韦或膦甲酸钠有效治疗后，且在开始使用伐昔洛韦时无CMV抗原血症）。两个治疗组在供体-受体CMV血清学状态和其他移植前特征方面匹配良好。通过使用市售免疫荧光测定法检测循环白细胞中CMV低基质蛋白pp65的血抗原血症试验来检测CMV再激活。对于一级预防，接受伐昔洛韦的12例患者中有3例CMV再激活，而对照组的31例患者中有24例（P<0.001）。对于二级预防，19例接受伐昔洛韦治疗的患者中有5例再激活，而24例对照患者中有16例（P<0.05）。除了偶尔出现的轻度胃肠道副作用外，伐昔洛韦耐受性良好。两组CMV疾病的发生率没有差异。在异基因SCT后，对有风险的患者进行伐昔洛韦预防似乎在预防原发性和继发性CMV再激活方面是安全有效的。需要更大规模的前瞻性随机研究来证实这些观察结果。
