Chang Hung, Tang Tzung-Chih, Hung Yu-Shin, Lin Tung-Liang, Kuo Ming-Chung, Wang Po-Nan
Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC.
Chang Gung Med J. 2011 Jan-Feb;34(1):65-74.
Cytomegalovirus (CMV) infection is uncommon in hematology patients. The clinical pictures and outcomes of this virus are not entirely clear.
Consecutive cases of CMV infection (17 patients with 20 episodes) were compiled for study over a six year period.
CMV infection occurred in patients of various ages and with a number of underlying hematological diseases, including non-Hodgkin's lymphoma, multiple myeloma (MM), acute myeloid leukemia (AML) and myeloproliferative neoplasm, No single laboratory assay was sensitive enough to serve as a screening test in the diagnosis of CMV infection. A combination of laboratory assays, clinical features and radiographic findings were required for diagnosis. All patients with AML or MM had received various chemotherapies before CMV infection. All but one lymphoma patient had received steroids and rituximab treatment prior to CMV infection. CMV infection episodes were accompanied by various co-infections in 60% (12/20) of cases. Bacterial lobar pneumonia was the most common form of co-infection. We used ganciclovir as the sole antiviral treatment in most of the infection episodes (18/20). Anti-CMV immunoglobulin (cytotect) was also provided to one patient because of persistent fever and dyspnea. Treatment was successful in all but one of the cases, which occurred when ganciclovir was initiated after respiratory failure. This patient died of CMV pneumonia. The other patients had good initial responses to antiviral treatment, but their long-term outcome was poor. Only five patients survived after a short follow-up duration.
In an era of intensive immuno-chemotherapy, CMV infection may become a serious threat for hematology patients. Physicians dealing with hematological malignancies should be aware of CMV infection, especially for patients receiving rituximab and steroids.
巨细胞病毒（CMV）感染在血液学患者中并不常见。这种病毒的临床表现和结局尚不完全清楚。
收集了六年期间连续发生的CMV感染病例（17例患者共20次发作）进行研究。
CMV感染发生在不同年龄以及患有多种潜在血液系统疾病的患者中，包括非霍奇金淋巴瘤、多发性骨髓瘤（MM）、急性髓系白血病（AML）和骨髓增殖性肿瘤。没有单一的实验室检测方法足够敏感，可作为CMV感染诊断的筛查试验。诊断需要结合实验室检测、临床特征和影像学表现。所有AML或MM患者在CMV感染前均接受了各种化疗。除一名淋巴瘤患者外，所有患者在CMV感染前均接受了类固醇和利妥昔单抗治疗。60%（12/20）的CMV感染发作伴有各种合并感染。细菌性大叶性肺炎是最常见的合并感染形式。在大多数感染发作中（18/20），我们使用更昔洛韦作为唯一的抗病毒治疗。由于持续发热和呼吸困难，还为一名患者提供了抗CMV免疫球蛋白（cytotect）。除1例病例外，所有病例治疗均成功，该例在呼吸衰竭后开始使用更昔洛韦，患者死于CMV肺炎。其他患者对抗病毒治疗有良好的初始反应，但长期结局较差。短期随访后只有5名患者存活。
在强化免疫化疗时代，CMV感染可能成为血液学患者的严重威胁。治疗血液系统恶性肿瘤的医生应意识到CMV感染，尤其是接受利妥昔单抗和类固醇治疗的患者。
