Ayala E, Greene J, Sandin R, Perkins J, Field T, Tate C, Fields K K, Goldstein S
H Lee Moffitt Cancer Center, Tampa, FL, USA.
Bone Marrow Transplant. 2006 May;37(9):851-6. doi: 10.1038/sj.bmt.1705341.
Despite significant advances in prevention and therapy, cytomegalovirus (CMV) infection continues to be an important cause of morbidity and mortality in the hematopoietic stem cell transplant (HSCT) recipient. The standard drug for pre-emptive therapy is intravenous ganciclovir (GCV). Valganciclovir (VGC), the oral pro-drug of GCV, has excellent bioavailability and is ideal for oral therapy. Since March 2002, VGC was adopted in our center for outpatient pre-emptive therapy in all patients undergoing allogeneic HSCT. Fifty-two allogeneic HSCT recipients were followed weekly via Digene hybrid capture assay. Patients with a positive assay were treated with VGC 900 mg p.o. b.i.d. x 14 days followed by 900 mg p.o. QD until at least 7 days after a negative test. Eighteen patients (14 sib, four MUD) had 30 episodes of CMV DNA detection treated with oral VGC. Median duration of therapy was 21 days (range 10-21 days). The rate of response was 93% (28/30) as confirmed by a negative assay within 14 days. No significant toxicity was encountered. Two patients failed oral VGC. One case of CMV enteritis was diagnosed in a patient with acute GVHD. Pre-emptive therapy of CMV infection with oral VGC is safe and effective in allogeneic HSCT recipients.
尽管在预防和治疗方面取得了重大进展，但巨细胞病毒（CMV）感染仍然是造血干细胞移植（HSCT）受者发病和死亡的重要原因。抢先治疗的标准药物是静脉注射更昔洛韦（GCV）。缬更昔洛韦（VGC）是GCV的口服前体药物，具有出色的生物利用度，是口服治疗的理想选择。自2002年3月以来，我们中心采用VGC对所有接受异基因HSCT的患者进行门诊抢先治疗。通过Digene杂交捕获试验每周对52名异基因HSCT受者进行随访。检测呈阳性的患者接受VGC 900 mg口服，每日两次，共14天，然后900 mg口服，每日一次，直至检测呈阴性后至少7天。18名患者（14名同胞，4名无关供者）发生30次CMV DNA检测阳性，接受口服VGC治疗。中位治疗持续时间为21天（范围10 - 21天）。14天内检测呈阴性证实缓解率为93%（28/30）。未遇到明显毒性。两名患者口服VGC治疗失败。1例急性移植物抗宿主病（GVHD）患者被诊断为CMV肠炎。口服VGC对异基因HSCT受者进行CMV感染的抢先治疗是安全有效的。
