Hazar Volkan, Ugur Aynur, Colak Dilek, Saba Rabin, Tezcan Gulsun, Kupesiz Alphan, Karadogan Ihsan, Gultekin Meral, Yesilipek Akif, Undar Levent
Department of Pediatric Hematology and Oncology, Akdeniz University Faculty of Medicine, Antalya, Turkey.
Jpn J Infect Dis. 2006 Aug;59(4):216-21.
Cytomegalovirus (CMV) disease is a frequent cause of morbidity and mortality following allogeneic hematopoietic stem cell transplantation. In order to investigate the relationships between antigenemia, high-dose acyclovir (HDACV) prophylaxis, preemptive ganciclovir (GCV) therapy, and outcomes, we analyzed the records of 105 patients, including both pediatric and adult populations, who underwent allogeneic peripheral blood stem cell transplantation (PBSCT) and who were at risk for CMV reactivation and disease (both recipient and donor seropositive). All received HDACV until neutrophil engraftment, but prophylaxis was continued till post-transplant day 180 only in pediatric patients in conjunction with weekly CMV pp65 antigenemia monitoring. Antigenemia-guided preemptive strategy with GCV was used for all patients. CMV antigenemia developed in 45 patients (42.9%) and CMV disease in 13 (12.4%). The frequencies for antigenemia were 31.3 and 63.2% in pediatric and adult groups (P = 0.002). All CMV diseases were in the adult group (P<0.001). Age at transplantation, underlying disease, long-term HDACV prophylaxis and acute graft versus host disease (aGVHD) were all found to be a significant risk factors for antigenemia. All of these factors other than aGVHD and conditioning regimen were also the significant risk factors for CMV disease. However, when we analyzed the pediatric and adult patients separately, dropping "long-term HDACV prophylaxis," none of these parameters were significant risk factors for CMV disease. In conclusion, we hypothesize that long-term HDACV prophylaxis in the GCV era results in a low incidence of CMV reactivation and disease in patients undergoing PBSCT.
巨细胞病毒（CMV）疾病是异基因造血干细胞移植后发病和死亡的常见原因。为了研究抗原血症、高剂量阿昔洛韦（HDACV）预防、抢先使用更昔洛韦（GCV）治疗与预后之间的关系，我们分析了105例患者的记录，这些患者包括儿童和成人，均接受了异基因外周血干细胞移植（PBSCT），且有CMV重新激活和发病的风险（受体和供体血清学均为阳性）。所有患者在中性粒细胞植入前均接受HDACV治疗，但仅儿童患者在移植后第180天继续进行预防，并每周监测CMV pp65抗原血症。所有患者均采用抗原血症引导的GCV抢先治疗策略。45例患者（42.9%）出现CMV抗原血症，13例（12.4%）发生CMV疾病。儿童组和成人组抗原血症的发生率分别为31.3%和63.2%（P = 0.002）。所有CMV疾病均发生在成人组（P<0.001）。移植时的年龄、基础疾病、长期HDACV预防和急性移植物抗宿主病（aGVHD）均被发现是抗原血症的显著危险因素。除aGVHD和预处理方案外，所有这些因素也是CMV疾病的显著危险因素。然而，当我们分别分析儿童和成人患者时，去掉“长期HDACV预防”后，这些参数均不是CMV疾病的显著危险因素。总之，我们推测在GCV时代，长期HDACV预防可使接受PBSCT的患者CMV重新激活和疾病的发生率较低。
