Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Eur J Cancer. 2009 Dec;45(18):3131-48. doi: 10.1016/j.ejca.2009.08.010. Epub 2009 Sep 30.
Antiviral prophylaxis is commonly prescribed to haematological cancer patients. We conducted a systematic review and meta-analysis to quantify its overall benefit in specific clinical scenarios.
Randomised controlled trials assessing antiviral prophylaxis versus placebo, no treatment, pre-emptive treatment or another antiviral drug were included. Patients undergoing haematopoietic stem cell transplantation (HSCT) or intensive chemotherapy for acute leukaemia or high-grade lymphoma were included. No restrictions on language, year or publication status were applied. Overall mortality, herpes simplex virus (HSV) and cytomegalovirus (CMV) diseases were assessed as primary outcomes. Pooled relative risks (RRs) and numbers needed to treat (NNT) with 95% confidence intervals (CI) are reported.
HSCT was the condition assessed in 22 trials and intensive chemotherapy in 5 trials. In the pre-engraftment setting of autologous or allogeneic HSCT, antiviral prophylaxis (mainly acyclovir for HSV seropositive recipients) significantly reduced HSV (NNT 2, 2-2, control event rate (CER) 61.9%) and CMV disease, with no effect on overall mortality. In the allogeneic post-engraftment setting (mainly CMV-seropositive recipients/donors), antiviral prophylaxis resulted in a significant reduction in overall mortality, RR 0.79 (0.65-0.95), NNT 12 (7-50, CER 39.4%) and all viral-related outcomes. In this setting, acyclovir significantly reduced overall mortality (RR 0.71, 0.53-0.96, 4 trials) and ganciclovir/maribavir significantly reduced CMV disease (RR 0.26, 0.14-0.48, 5 trials). During chemotherapy, acyclovir significantly decreased HSV disease (NNT 3, 2-4, CER 37.4%) and infection rates, with no effect on mortality.
Antiviral prophylaxis reduced mortality with a small NNT in the post-engraftment setting of allogeneic HSCT. In the pre-engraftment phase and during chemotherapy only viral-related morbidity was reduced.
抗病毒预防常用于血液系统恶性肿瘤患者。我们进行了系统评价和荟萃分析，以量化其在特定临床情况下的总体获益。
纳入评估抗病毒预防与安慰剂、无治疗、抢先治疗或其他抗病毒药物比较的随机对照试验。纳入接受造血干细胞移植（HSCT）或急性白血病或高级别淋巴瘤强化化疗的患者。不限制语言、年份或出版状态。主要结局为总体死亡率、单纯疱疹病毒（HSV）和巨细胞病毒（CMV）疾病。报告汇总相对风险（RR）和 95%置信区间（CI）的需要治疗人数（NNT）。
22 项试验评估了 HSCT，5 项试验评估了强化化疗。在自体或异基因 HSCT 的植入前阶段，抗病毒预防（主要为 HSV 阳性接受者的阿昔洛韦）显著降低 HSV（NNT2，2-2，对照事件率（CER）61.9%）和 CMV 疾病，对总体死亡率无影响。在异基因植入后阶段（主要为 CMV 阳性接受者/供者），抗病毒预防可显著降低总体死亡率，RR0.79（0.65-0.95），NNT12（7-50，CER39.4%）和所有病毒相关结局。在这种情况下，阿昔洛韦显著降低总体死亡率（RR0.71，0.53-0.96，4 项试验），更昔洛韦/马拉韦尔显著降低 CMV 疾病（RR0.26，0.14-0.48，5 项试验）。在化疗期间，阿昔洛韦可显著降低 HSV 疾病（NNT3，2-4，CER37.4%）和感染率，对死亡率无影响。
在异基因 HSCT 的植入后阶段，抗病毒预防可降低死亡率，NNT 较小。在植入前阶段和化疗期间，仅降低了病毒相关发病率。
