Nguyen Dorothy D, Cao Thai M, Dugan Kathleen, Starcher Stacey A, Fechter R Lenn, Coutre Steven E
Department of Medicine, Division of Hematology, Stanford University School of Medicine, Stanford, CA 94305, USA.
Clin Lymphoma. 2002 Sep;3(2):105-10. doi: 10.3816/clm.2002.n.016.
Campath-1H is effective therapy for patients with relapsed and refractory chronic lymphocytic leukemia (CLL) and prolymphocytic leukemia (PLL), but it is associated with profound lymphopenia and deficiencies in cell-mediated immunity. We report the incidence of cytomegalovirus (CMV) viremia in 34 patients treated with Campath-1H for relapsed or refractory CLL and PLL. All patients received infection prophylaxis during therapy and continuing for at least 2 months following Campath-1H. Five patients (15%) developed CMV viremia at a median of 28 days (range, 20-30 days) after the first dose of Campath-1H. The median CMV viral load was 860/mL (range, 420-2100/mL), as determined by quantitative plasma polymerase chain reaction (PCR). All 5 patients had a temperature > 38.5 degrees C, normal chest radiographs, normal liver function tests, and negative bacterial blood cultures with no clinical evidence of CMV disease at the time of presentation with CMV viremia. The median absolute neutrophil count (ANC) was 740/ microL (range, 340-1600/ microL), and the median absolute lymphocyte count (ALC) was 16/microL (range, 11-169/ microL) for the 5 patients at the time of CMV viremia. All 5 patients received ganciclovir therapy followed by prompt fever resolution and clearance of CMV viremia by plasma PCR. By univariate regression analysis, the following were not risk factors for CMV viremia: age, number of prior regimens, prior rituximab therapy, prior splenectomy, modified Rai stage at Campath-1H therapy (low/intermediate vs. high), ANC, and ALC; although, there was a trend towards significance for prior rituximab therapy (P = 0.07). Cytomegalovirus viremia may be a significant infectious complication during Campath-1H therapy and should be investigated further in future studies.
Campath-1H是复发难治性慢性淋巴细胞白血病（CLL）和幼淋巴细胞白血病（PLL）患者的有效治疗方法，但它与严重淋巴细胞减少和细胞介导免疫缺陷有关。我们报告了34例接受Campath-1H治疗复发或难治性CLL和PLL患者的巨细胞病毒（CMV）病毒血症发生率。所有患者在治疗期间接受感染预防，并在Campath-1H治疗后持续至少2个月。5例患者（15%）在首次使用Campath-1H后中位28天（范围20 - 30天）出现CMV病毒血症。通过定量血浆聚合酶链反应（PCR）测定，CMV病毒载量中位数为860/mL（范围420 - 2100/mL）。所有5例患者体温>38.5℃，胸部X线片正常，肝功能检查正常，细菌血培养阴性，在出现CMV病毒血症时无CMV疾病的临床证据。5例患者在CMV病毒血症时的中位绝对中性粒细胞计数（ANC）为740/μL（范围340 - 1600/μL），中位绝对淋巴细胞计数（ALC）为16/μL（范围11 - 169/μL）。所有5例患者均接受更昔洛韦治疗，随后发热迅速消退，血浆PCR检测CMV病毒血症清除。单因素回归分析显示，以下因素不是CMV病毒血症的危险因素：年龄、既往治疗方案数量、既往利妥昔单抗治疗、既往脾切除术、Campath-1H治疗时改良Rai分期（低/中与高）、ANC和ALC；不过，既往利妥昔单抗治疗有显著趋势（P = 0.07）。CMV病毒血症可能是Campath-1H治疗期间的一种重要感染并发症，未来研究应进一步探讨。
