Kaynar Leylagül, Metan Gökhan, Gökahmetoğlu Selma, Kurnaz Fatih, Mumcuoğlu Haluk, Öztürk Ahmet, Şıvgın Serdar, Pala Ciğdem, Yıldız Orhan, Eser Bülent, Ünal Ali, Çetin Mustafa
Erciyes University Faculty of Medicine, Kayseri, Turkey.
J Chemother. 2013 Oct;25(5):286-91. doi: 10.1179/1973947813Y.0000000082.
The aim of this retrospective study was to compare the efficacy and safety of standard intravenous ganciclovir (GCV) with low-dose oral valganciclovir (VGC) in preemptive treatment of cytomegalovirus (CMV) infection in patients who received allogeneic stem cell transplantation (ASCT). Fifty-nine adult ASCT patients with asymptomatic 68 CMV reactivations were included. For preemptive CMV treatment, VGC (900 mg/day) in 44 reactivations or GCV (5 mg/kg twice daily during the first week and once daily afterwards) in 24 CMV reactivations were administered for 21 days. Two consecutive negative results for PCR and/or CMV antigenemia were considered as treatment success. All patients with CMV reactivations were on immunosuppressive treatment. While no positivity was identified in any of the patients who received GCV on day 21, low-titer CMV positivity was noted in three of the patients in the VGC group (P = 0·264). In all three patients, VGC was continued at same dose and no positivity result was detected after 2-3 weeks. Low-grade neutropenia and high grade thrombocytopenia were significantly higher in the GCV group than in the VGC group (P = 0·018 and P = 0·04 respectively). Preemptive strategy of oral low-dose VGC appears preferable to the prevention of CMV disease in ASCT. These results require confirmation in prospective larger clinical studies.
这项回顾性研究的目的是比较标准静脉注射更昔洛韦（GCV）与低剂量口服缬更昔洛韦（VGC）对接受异基因干细胞移植（ASCT）患者进行巨细胞病毒（CMV）感染抢先治疗的疗效和安全性。纳入了59例发生无症状CMV再激活的成年ASCT患者。对于抢先性CMV治疗，44例再激活患者接受VGC（900毫克/天）治疗，24例CMV再激活患者接受GCV（第一周每天两次，每次5毫克/千克，之后每天一次）治疗，持续21天。连续两次PCR和/或CMV抗原血症检测结果为阴性被视为治疗成功。所有发生CMV再激活的患者均接受免疫抑制治疗。接受GCV治疗的患者在第21天时均未检测到阳性结果，而VGC组有3例患者检测到低滴度CMV阳性（P = 0.264）。在这3例患者中，均继续使用相同剂量的VGC治疗，2至3周后未检测到阳性结果。GCV组的轻度中性粒细胞减少和重度血小板减少显著高于VGC组（分别为P = 0.018和P = 0.04）。口服低剂量VGC的抢先治疗策略似乎比预防ASCT患者的CMV疾病更可取。这些结果需要在前瞻性更大规模的临床研究中得到证实。
