[The clinical evaluation of preemptive treatment of cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation].

OBJECTIVE

To retrospectively analyze the effect of preemptive treatment on cytomegalovirus (CMV) infection in patients receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODS

The data of one hundred and three patients who underwent allo-HSCT with preemptive treatment to prevent CMV associated diseases were retrospectively analyzed. Fluorescence quantitative PCR was used to detect CMV-DNA. The incidences of CMV viremia and CMV associated diseases were analyzed.

RESULTS

CMV viremia was confirmed 63 times in 51 of the 103 patients. The incidence of CMV viremia was 49.5% and the median time of onset was 40 days after transplantation. All the patients with CMV viremia received preemptive antiviral therapy and 19 of them developed CMV associated diseases, including 14 hemorrhagic cystitis, 3 CMV associated pneumonia and 2 CMV associated enteritis. The total incidence of CMV associated diseases was 18.4%. After treatment with ganciclovir and/or foscarnet, 60 of the 63 times of CMV viremia disappeared. One patient was not included in the analysis because he died of intracranial hemorrhage and GVHD only 3 days after the treatment. The total response rate was 96.8% (60/62). The remaining two cases who did not respond to treatment died of CMV associated pneumonia in combination with acute GVHD. The direct mortality rate of CMV infection was 1.9% (2/103).

CONCLUSION

The incidences of CMV viremia and CMV associated diseases do not increase in patients receiving preemptive therapy as compared with those receiving prophylaxis therapy. Preemptive treatment can not only prevent the progression of CMV viremia to CMV associated diseases in majority of the cases but also control CMV associated diseases effectively.