Emanuel D, Cunningham I, Jules-Elysee K, Brochstein J A, Kernan N A, Laver J, Stover D, White D A, Fels A, Polsky B
Memorial Sloan-Kettering Cancer Center, New York, New York.
Ann Intern Med. 1988 Nov 15;109(10):777-82. doi: 10.7326/0003-4819-109-10-777.
To assess the efficacy of the combination of the antiviral agent ganciclovir (9-1,3 dihydroxy-2-propoxymethylguanine) and high-dose intravenous immune globulin for treating cytomegalovirus interstitial pneumonitis after allogeneic bone marrow transplantation.
Nonrandomized prospective trial of combined treatment with two drugs; findings in these patients were compared with those in control patients treated with either of the two drugs alone.
Medical, pediatric, and intensive care units of a tertiary-care cancer treatment center.
Consecutive cases of 10 patients in the study group and of 11 patients in a historical control group with evidence of cytomegalovirus pneumonia after bone marrow transplantation for treatment of leukemia or congenital immune deficiency.
Study Group (10 patients): ganciclovir, 2.5 mg/kg body weight, three times daily for 20 days, plus intravenous immune globulin, 500 mg/kg every other day for ten doses. Patients were then given ganciclovir, 5 mg/kg.d three to five times a week for 20 more doses, and intravenous immune globulin, 500 mg/kg twice a week for 8 more doses. Control Group (11 patients): ganciclovir alone (2 patients), 5 mg/kg twice a day for 14 to 21 days; cytomegalovirus hyperimmune globulin (5 patients), 400 mg/kg.d for 10 days; and intravenous immune globulin (4 patients), 400 mg/kg.d for 10 days.
Responses were observed in all patients treated with combination therapy; 7 of 10 patients were alive and well, and had no recurrence of disease at a median of 10 months after therapy. No therapeutic benefit was observed, and none of the 11 patients treated with either ganciclovir or intravenous immune globulin alone survived (P = 0.001 by Fisher exact test).
Ganciclovir, when combined with high-dose intravenous immune globulin, appears to have significantly altered the outcome of patients with cytomegalovirus pneumonia after allogeneic bone marrow transplantation.
评估抗病毒药物更昔洛韦（9-1,3-二羟基-2-丙氧甲基鸟嘌呤）与大剂量静脉注射免疫球蛋白联合应用治疗异基因骨髓移植后巨细胞病毒间质性肺炎的疗效。
两种药物联合治疗的非随机前瞻性试验；将这些患者的研究结果与单独使用两种药物之一治疗的对照患者的结果进行比较。
一家三级癌症治疗中心的内科、儿科和重症监护病房。
研究组连续入选10例患者，历史对照组连续入选11例患者，均为因白血病或先天性免疫缺陷接受骨髓移植后出现巨细胞病毒肺炎证据的患者。
研究组（10例患者）：更昔洛韦，2.5mg/kg体重，每日3次，共20天，加静脉注射免疫球蛋白，每隔一天500mg/kg，共10剂。然后给患者更昔洛韦，5mg/kg·d，每周3至5次，共20剂，静脉注射免疫球蛋白，每周2次，500mg/kg，共8剂。对照组（11例患者）：单独使用更昔洛韦（2例患者），5mg/kg，每日2次，共14至21天；巨细胞病毒高免疫球蛋白（5例患者），400mg/kg·d，共10天；静脉注射免疫球蛋白（4例患者），400mg/kg·d，共10天。
联合治疗的所有患者均有反应；10例患者中有7例存活且状况良好，治疗后中位10个月疾病无复发。单独使用更昔洛韦或静脉注射免疫球蛋白治疗的11例患者均未观察到治疗益处，无一例存活（Fisher精确检验P=0.001）。
更昔洛韦与大剂量静脉注射免疫球蛋白联合应用似乎显著改变了异基因骨髓移植后巨细胞病毒肺炎患者的预后。
