Division of Hematology-Oncology, Department of Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
Int J Hematol. 2010 Jun;91(5):886-91. doi: 10.1007/s12185-010-0580-2. Epub 2010 May 8.
We studied the efficacy of two different doses of ganciclovir to prevent cytomegalovirus (CMV) disease in allogeneic hematopoietic stem cell transplantation (HSCT) recipients. We randomly assigned allogeneic HSCT recipients who had CMV infection to receive preemptive ganciclovir therapy with or without induction phase (5 mg/kg twice daily for 1 week). Thirty-two and thirty-six patients were randomized to the standard and the low-dose therapy group, respectively. The median time to CMV antigenemia or viremia clearance was 7 days (3-25 days) in the standard therapy group versus 11 days (3-69 days) in the low-dose therapy group (P = 0.540). The incidence of CMV disease was similar between the two groups (P = 0.366). The Kaplan-Meier estimate of event-free survival by day 180 after HSCT was 76.2% in the standard therapy group versus 66.7% in the low-dose therapy group (P = 0.590). Severe neutropenia (<0.5 x 10(9)/L) was observed in four (12.5%) patients in the standard therapy group versus two (5.6%) patients in the low-dose therapy group (P = 0.314). This study suggests that a low-dose ganciclovir preemptive therapy can be as effective as the standard-dose ganciclovir preemptive therapy for the prevention of CMV disease in allogeneic HSCT recipients.
我们研究了两种不同剂量更昔洛韦预防异基因造血干细胞移植（HSCT）受者巨细胞病毒（CMV）病的疗效。我们将 CMV 感染的异基因 HSCT 受者随机分配接受抢先性更昔洛韦治疗，或联合或不联合诱导期（5mg/kg，每日两次，持续 1 周）。32 例和 36 例患者分别随机分配到标准剂量和低剂量治疗组。标准治疗组 CMV 抗原血症或病毒血症清除的中位时间为 7 天（3-25 天），而低剂量治疗组为 11 天（3-69 天）（P=0.540）。两组 CMV 病的发生率相似（P=0.366）。HSCT 后 180 天无事件生存的 Kaplan-Meier 估计，标准治疗组为 76.2%，低剂量治疗组为 66.7%（P=0.590）。标准治疗组有 4 例（12.5%）患者出现严重中性粒细胞减少症（<0.5x10(9)/L），而低剂量治疗组有 2 例（5.6%）患者出现严重中性粒细胞减少症（P=0.314）。本研究表明，低剂量更昔洛韦抢先治疗与标准剂量更昔洛韦抢先治疗预防异基因 HSCT 受者 CMV 病一样有效。
