[A comparative study of the curative effects of cytomegalovirus preemptive therapy in various kinds of hematopoietic stem-cell transplantation].

OBJECTIVE

Coherent preemptive therapy criterion was applied in various kinds of allogenic hematopoietic stem-cell transplant (allo-HSCT) recipients with cytomegalovirus (CMV) infection in order to evaluate its clinical value in various kinds of HSCT.

METHODS

A total of 318 allo-HSCT patients were monitored for CMV infection. Real-time quantitative polymerase chain reaction (RQ-PCR) was performed to serially monitor CMV viremia after transplantation. There were 136 patients infected with CMV including 31 of HLA-matched sibling, 88 of HLA-mismatched related and 17 of unrelated donor HSCT. Coherent preemptive therapy criterion was employed. The clearance rate of DNAemia, incidence of CMV disease and overall survival rate were compared among the three types of HSCT.

RESULTS

All the 136 patients with CMV DNAemia were treated with ganciclovir, foscarnet and valganciclovir, respectively. The period of treatment and the clearance rate of DNAemia were comparable among the HLA-matched, HLA-mismatched related and unrelated donor HSCT groups (96.8%, 93.2% and 88.2%) (P > 0.05). The incidence of CMV pneumonia and CMV enteritis and overall survival rate among the three groups were similar and there was no significant difference in the proportion of patients dying of CMV diseases (P > 0.05). However, the overall survival rate of the patients with II-IV acute graft-versus-host disease (aGVHD) was much lower than that of the patients with 0- I aGVHD.

CONCLUSION

Similar curative effect can be observed when preemptive therapy is applied in various kinds of allo-HSCT recipients with cytomegalovirus infection based on the results of RQ-PCR.