Service of Hematology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Expert Rev Hematol. 2011 Feb;4(1):9-16. doi: 10.1586/ehm.10.77.
The aim of this study was to assess the incidence of cytomegalovirus (CMV) infection and disease in patients with hematologic malignancies treated with alemtuzumab. The outcome of CMV infection in hematologic patients treated with alemtuzumab in 19 hospitals throughout Spain was assessed retrospectively. Data were collected from the medical records of patients over a period of 6 months following initiation of alemtuzumab therapy. We studied 102 patients (89 with B-cell chronic lymphocytic leukemia and 13 with other lymphoproliferative diseases, with a median age of 63 years [range 29-81 years]). Alemtuzumab was administered for a mean of 11.2 (standard deviation: 13.8) weeks, with a median total dose of 423 mg (range: 59-1440 mg). Alemtuzumab as a single agent was administered in 92.2% of patients and was associated with chemotherapy in 7.8% of cases. Prophylactic antivirals included famcyclovir (47%), acyclovir (34%), valacyclovir (14%) and valgancyclovir (5%). CMV viremia testing was performed a mean of 6.3 times (range: 1-19). The incidence of CMV infection was 38.9% (46% in patients treated with steroids and 75% in patients receiving ≥1000 mg of alemtuzumab). Treatment of CMV infection included gancyclovir or valgancyclovir in 94% of cases. Viremia became negative after a median of 20 days (95% CI: 13.4-26.6). CMV disease occurred in five patients. The incidence of CMV infection in alemtuzumab-treated patients was 38.9%. The incidence increased in patients treated concomitantly with steroids and in those treated with high doses of alemtuzumab, although only eight patients received 1000 mg or more, systematic monitoring of CMV viremia and early treatment of infection resulted in a favorable outcome of CMV reactivation.
本研究旨在评估接受阿仑单抗治疗的血液恶性肿瘤患者巨细胞病毒 (CMV) 感染和疾病的发生率。回顾性评估了西班牙 19 家医院接受阿仑单抗治疗的血液系统恶性肿瘤患者的 CMV 感染结局。在开始阿仑单抗治疗后 6 个月的时间内，从患者的病历中收集数据。我们研究了 102 例患者（89 例为 B 细胞慢性淋巴细胞白血病，13 例为其他淋巴增殖性疾病，中位年龄为 63 岁 [范围 29-81 岁]）。阿仑单抗的中位使用时间为 11.2 周（标准差：13.8），中位总剂量为 423 mg（范围：59-1440 mg）。92.2%的患者接受阿仑单抗单药治疗，7.8%的患者接受阿仑单抗联合化疗。预防性抗病毒药物包括法昔洛韦（47%）、阿昔洛韦（34%）、伐昔洛韦（14%）和缬更昔洛韦（5%）。CMV 病毒血症检测的中位数为 6.3 次（范围：1-19）。CMV 感染的发生率为 38.9%（接受类固醇治疗的患者为 46%，接受≥1000 mg 阿仑单抗治疗的患者为 75%）。CMV 感染的治疗包括更昔洛韦或缬更昔洛韦，在 94%的病例中。病毒血症在中位数 20 天（95%CI：13.4-26.6）后转为阴性。5 例患者发生 CMV 疾病。阿仑单抗治疗患者的 CMV 感染发生率为 38.9%。在同时接受类固醇治疗和接受高剂量阿仑单抗治疗的患者中，感染发生率增加，尽管只有 8 例患者接受了 1000 mg 或更多的剂量，但系统监测 CMV 病毒血症和早期治疗感染导致 CMV 再激活的结局良好。
