Reed E C, Shepp D H, Dandliker P S, Meyers J D
Fred Hutchinson Cancer Research Center, Seattle, WA 98104.
Bone Marrow Transplant. 1988 May;3(3):199-206.
Ganciclovir, an acyclic nucleoside with improved activity against cytomegalovirus in vitro, was used to treat 15 marrow transplant patients with symptomatic cytomegalovirus infection of the gastrointestinal tract. Eleven of the 15 had improvement in one or more of their clinical signs or symptoms during treatment. No clinical relapses were observed. Viral excretion from throat, urine and blood stopped at a median of 6 days of treatment, but six patients had recurrence of viral excretion 7-25 days after treatment was stopped. The only toxicity was the development of reversible neutropenia in eight of 15 patients after 10-19 days of treatment. Neutropenia was not related to duration of treatment, plasma drug levels or to the neutrophil count at the beginning of treatment. Although treatment with ganciclovir may be associated with marrow suppression, the serious nature of gastrointestinal infection due to cytomegalovirus in the immunocompromised host, the antiviral effect and the possible clinical improvement observed in vivo, and the lack of other effective treatments justify further controlled studies with this agent in immunocompromised patients with serious cytomegalovirus infection.
更昔洛韦是一种体外抗巨细胞病毒活性有所提高的无环核苷，用于治疗15例有症状的胃肠道巨细胞病毒感染的骨髓移植患者。15例患者中有11例在治疗期间一种或多种临床体征或症状有所改善。未观察到临床复发。治疗6天时，咽喉、尿液和血液中的病毒排出停止，但6例患者在停药后7 - 25天病毒排出复发。唯一的毒性反应是15例患者中有8例在治疗10 - 19天后出现可逆性中性粒细胞减少。中性粒细胞减少与治疗持续时间、血浆药物水平或治疗开始时的中性粒细胞计数无关。尽管更昔洛韦治疗可能与骨髓抑制有关，但在免疫功能低下宿主中巨细胞病毒引起的胃肠道感染的严重性、抗病毒作用以及体内观察到的可能的临床改善，加上缺乏其他有效治疗方法，证明有必要对该药物在患有严重巨细胞病毒感染的免疫功能低下患者中进行进一步的对照研究。
