Chow J M, Lin M T, Chen Y C, Chang S C, Su I J, Tang J L
Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, R.O.C.
J Formos Med Assoc. 1992 Oct;91(10):996-1000.
A 35-year-old man with acute lymphoblastic leukemia in second remission received an allogeneic bone marrow transplant from an HLA-compatible sibling donor. Unfortunately, cytomegalovirus (CMV) pneumonitis was histologically documented on Day +72. Combination therapy with ganciclovir (9-[2-hydroxy-1-(hydroxy-methyl) ethoxymethyl] guanine) and high-dose intravenous immunoglobulin (IVIG) was started immediately. The treatment comprised a three-week induction course (ganciclovir, 2.5 mg/kg q8h and IVIG, 500 mg/kg qod) and a seven-week fixed-dose maintenance course (ganciclovir 5 mg/kg thrice a week for 20 doses and IVIG 500 mg/kg twice a week for eight doses). The pneumonia resolved gradually, and he was free from symptoms within two weeks. The only significant side effect was moderately severe myelosuppression which was reversible after discontinuation of ganciclovir. The patient had a relapse of leukemia on Day +186, but there was no recurrence of CMV pneumonitis. This result confirms that such combination therapy is effective in the treatment of CMV pneumonitis in a patient with a bone marrow transplant.
一名处于第二次缓解期的35岁急性淋巴细胞白血病男性患者接受了来自HLA配型相合的同胞供者的异基因骨髓移植。不幸的是，在+72天时经组织学证实发生了巨细胞病毒（CMV）肺炎。立即开始使用更昔洛韦（9-[2-羟基-1-(羟甲基)乙氧基甲基]鸟嘌呤）和大剂量静脉注射免疫球蛋白（IVIG）进行联合治疗。治疗包括一个为期三周的诱导疗程（更昔洛韦，2.5mg/kg，每8小时一次；IVIG，500mg/kg，隔日一次）和一个为期七周的固定剂量维持疗程（更昔洛韦5mg/kg，每周三次，共20剂；IVIG 500mg/kg，每周两次，共8剂）。肺炎逐渐消退，患者在两周内症状消失。唯一显著的副作用是中度严重的骨髓抑制，在停用更昔洛韦后可逆转。该患者在+186天时白血病复发，但CMV肺炎未复发。这一结果证实，这种联合治疗对骨髓移植患者的CMV肺炎治疗有效。
