Tavil Betul, Azik Fatih Mehmet, Bozkaya Ikbal, Gokcebay Dilek Gurlek, Tezer Hasan, Tunc Bahattin, Uckan Duygu
From the Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey.
Exp Clin Transplant. 2014 Oct;12(5):462-8.
The purpose of this study was to evaluate the effectiveness of acyclovir prophylaxis and preemptive ganciclovir treatment in preventing cytomegalovirus disease in children who underwent hematopoietic stem cell transplant.
We reviewed the clinical records of 66 children (36 boys, 30 girls; mean age, 9 ± 5 y; age range, 2-20 y) who underwent hematopoietic stem cell transplant at Ankara Children's Hematology and Oncology Hospital, Bone Marrow Transplantation Unit, between April 2010 and March 2012.
In these 66 children, 61 children (92.4%) received allogeneic transplant; 50 children (76.9%) received a myeloablative regimen; and 14 children (21.2%) received anti-thymocyte globulin as part of the conditioning regimen. All children received acyclovir prophylaxis from the beginning of conditioning regimen until 100 days after transplant, and children received preemptive treatment with ganciclovir when cytomegalovirus DNAemia ≥ 400 copies/mL on 2 tests or ≥ 1000 copies/mL on 1 test. There were 19 children (28.8%) who had cytomegalovirus reactivation during median follow-up 381 days (range, 100-720 d). Cytomegalovirus disease was observed in only 2 patients (10.5%); 1 patient had cytomegalovirus hepatitis and 1 patient had cytomegalovirus gastrointestinal disease. Both patients were cured of cytomegalovirus with treatment for 1 month. There was no death attributable to cytomegalovirus reactivation and/or disease. Febrile neutropenia, acute graft-versus-host disease, and steroid use were more frequent in patients who had cytomegalovirus than did not have cytomegalovirus reactivation. The risk of cytomegalovirus reactivation was increased 5-fold in patients who used steroids.
Acyclovir prophylaxis and preemptive treatment with ganciclovir may be effective in preventing cytomegalovirus disease in most children who have hematopoietic stem cell transplant.
本研究旨在评估阿昔洛韦预防和抢先使用更昔洛韦治疗对接受造血干细胞移植儿童预防巨细胞病毒病的有效性。
我们回顾了2010年4月至2012年3月期间在安卡拉儿童血液学与肿瘤医院骨髓移植科接受造血干细胞移植的66名儿童（36名男孩，30名女孩；平均年龄9±5岁；年龄范围2 - 20岁）的临床记录。
在这66名儿童中，61名儿童（92.4%）接受了异基因移植；50名儿童（76.9%）接受了清髓性方案；14名儿童（21.2%）在预处理方案中接受了抗胸腺细胞球蛋白治疗。所有儿童从预处理方案开始至移植后100天均接受阿昔洛韦预防，当巨细胞病毒血症在2次检测中≥400拷贝/毫升或在1次检测中≥1000拷贝/毫升时，儿童接受更昔洛韦抢先治疗。在中位随访381天（范围100 - 720天）期间，有19名儿童（28.8%）出现巨细胞病毒再激活。仅2例患者（10.5%）观察到巨细胞病毒病；1例患者患有巨细胞病毒性肝炎，1例患者患有巨细胞病毒性胃肠道疾病。两名患者均经1个月治疗后治愈巨细胞病毒。没有因巨细胞病毒再激活和/或疾病导致的死亡。与未发生巨细胞病毒再激活的患者相比，发生巨细胞病毒的患者发热性中性粒细胞减少、急性移植物抗宿主病和使用类固醇更为频繁。使用类固醇的患者巨细胞病毒再激活风险增加5倍。
阿昔洛韦预防和更昔洛韦抢先治疗可能对大多数接受造血干细胞移植的儿童预防巨细胞病毒病有效。
