Humar A, Lipton J, Messner H, McGeer A, Mazzulli T
Department of Medicine, Division of Infectious Diseases, The Toronto Hospital;
Can J Infect Dis. 1999 Nov;10(6):410-4. doi: 10.1155/1999/480541.
To gather information about cytomegalovirus (CMV) prevention and treatment practices in bone marrow transplantation (BMT) in Canada.
A questionnaire was mailed to all centres across Canada performing BMT in January 1998. A second mailing was sent three months later.
Data on 15 centres performing allogeneic BMT (total patients 459) and 16 centres (total patients 703) performing autologous BMT were obtained.
For allogeneic BMT, all donors and recipients had pretransplant CMV serology performed. Nine centres gave CMV-negative blood to only donor-negative/recipient-negative patients, four centres to all patients and two centres to other subgroups. All allogeneic BMT centres had a strategy for CMV prevention. Three centres used universal ganciclovir prophylaxis, while 12 centres used some form of pre-emptive ganciclovir therapy based on weekly antigenemia assays (four centres), weekly polymerase chain reaction (two centres), CMV blood cultures (one centre), CMV throat and urine cultures (one centre), CMV screening bronchoscopy (two centres), or a combination of antigenemia plus bronchoscopy (two centres). The dose and duration of pre-emptive ganciclovir varied considerably from centre to centre. In addition, many centres used high dose acyclovir universally for a variable period of time post-BMT. For the treatment of CMV pneumonia, 14 centres used ganciclovir plus immunoglobulin (IG) and one centre used ganciclovir alone. Ganciclovir treatment duration ranged from two to 11 weeks and the number of doses of IG from three to 18. Thirteen of 16 autologous BMT centres screened patients for CMV pretransplant. Ten centres used CMV negative blood for some or all of their patients. Only one centre performed routine CMV monitoring after autologous BMT.
Practices for the prevention of CMV disease in BMT patients differ widely across centres, and further data may assist in developing a consensus regarding the optimal approach to CMV management.
收集有关加拿大骨髓移植（BMT）中巨细胞病毒（CMV）预防和治疗方法的信息。
1998年1月向加拿大所有开展BMT的中心邮寄了一份调查问卷。三个月后又进行了第二次邮寄。
获取了15个开展异基因BMT中心（患者总数459例）和16个开展自体BMT中心（患者总数703例）的数据。
对于异基因BMT，所有供者和受者移植前均进行了CMV血清学检测。9个中心仅向供者阴性/受者阴性的患者输注CMV阴性血液，4个中心向所有患者输注，2个中心向其他亚组患者输注。所有异基因BMT中心都有CMV预防策略。3个中心采用普遍使用更昔洛韦预防，而12个中心根据每周抗原血症检测（4个中心）、每周聚合酶链反应（2个中心）、CMV血培养（1个中心）、CMV咽喉和尿液培养（1个中心）、CMV筛查支气管镜检查（2个中心）或抗原血症加支气管镜检查联合使用（2个中心），采用某种形式的抢先使用更昔洛韦治疗。抢先使用更昔洛韦的剂量和疗程在不同中心差异很大。此外，许多中心在BMT后一段时间内普遍使用高剂量阿昔洛韦。对于CMV肺炎的治疗，14个中心使用更昔洛韦加免疫球蛋白（IG），1个中心仅使用更昔洛韦。更昔洛韦治疗疗程为2至11周，IG剂量为3至18剂。16个自体BMT中心中有13个在移植前对患者进行CMV筛查。10个中心对部分或所有患者使用CMV阴性血液。只有1个中心在自体BMT后进行常规CMV监测。
各中心在BMT患者中预防CMV疾病的方法差异很大，更多数据可能有助于就CMV管理的最佳方法达成共识。
