Crumpacker C, Marlowe S, Zhang J L, Abrams S, Watkins P
Department of Medicine, Beth Israel Hospital, Boston, Massachusetts 02215.
Rev Infect Dis. 1988 Jul-Aug;10 Suppl 3:S538-46. doi: 10.1093/clinids/10.supplement_3.s538.
In a multicenter uncontrolled trial of ganciclovir therapy for well-documented cytomegalovirus (CMV) pneumonia in 21 patients following bone marrow transplantation, eight (38%) of 21 survived for more than 90 days. Two additional patients responded to ganciclovir therapy; one survived for 60 days before relapsing with fatal CMV pneumonia, and the other survived 79 days before dying with disseminated aspergillosis. No CMV disease was found in this latter patient at autopsy. The improved survival of patients in this trial may be due to a small number of patients (23%) who developed significant neutropenia during ganciclovir therapy, to the concurrent use of CMV immune globulin in three of the survivors, or to other variables affecting a positive outcome. Data on the use of CMV DNA-DNA hybridization assays to detect CMV DNA directly in patients' blood suggest that this method may be useful in following the clearance of CMV viremia in patients receiving ganciclovir. The results of treatment of CMV pneumonia in bone marrow transplant recipients are compared with those of previous studies, of CMV pneumonia in renal transplant recipients, and of CMV pneumonia in patients with AIDS. Suggestions for further, more definitive, studies of CMV pneumonia are presented.
在一项针对21例骨髓移植后确诊为巨细胞病毒（CMV）肺炎患者的更昔洛韦治疗多中心非对照试验中，21例患者中有8例（38%）存活超过90天。另有2例患者对更昔洛韦治疗有反应；1例在复发致命性CMV肺炎前存活60天，另1例在死于播散性曲霉病前存活79天。尸检时在该例患者中未发现CMV疾病。该试验中患者存活率的提高可能归因于一小部分（23%）在更昔洛韦治疗期间出现严重中性粒细胞减少的患者、3例存活者同时使用了CMV免疫球蛋白，或其他影响良好预后的变量。关于使用CMV DNA-DNA杂交试验直接检测患者血液中CMV DNA的数据表明，该方法可能有助于监测接受更昔洛韦治疗患者的CMV病毒血症清除情况。将骨髓移植受者CMV肺炎的治疗结果与先前研究中肾移植受者CMV肺炎以及艾滋病患者CMV肺炎的治疗结果进行了比较。还提出了对CMV肺炎进行进一步更明确研究的建议。
