Li L, Wang Y, Yan C H, Huang X J
Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China.
Zhonghua Nei Ke Za Zhi. 2018 Mar 1;57(3):191-195. doi: 10.3760/cma.j.issn.0578-1426.2018.03.008.
To investigate the threshold of cytomegalovirus (CMV) DNAemia for preemptive antiviral therapy in patients with allogeneic hematopoietic stem cell transplantation (allo-HSCT). Viral load between 1×10(3) copies/ml and 5×10(3) copies/ml was defined as low viral load by real time Q-PCR. Clinical data and outcome were collected. A total of 95 allo-HSCT recipients with low viral load from September 2014 to February 2015 were recruited in this study. The control group included 37 patients who received preemptive initial antiviral therapy. The other 58 patients didn't received antiviral treatment after positive viremia was confirmed. During monitoring, CMV viremia was cleared spontaneously in 17 patients of study group. Among 41 patients with continuous positive viremia in study group, 26 patients received antiviral therapy after second positivity including 18 with viral load >5×10(3) copies/ml, 2 with fever but still low viral load, 2 with hemorrhagic cystitis and low viral load, 4 with continuous low viral load. Eleven patients received antiviral therapy after the third positivity including 5 with viral load >5×10(3) copies/ml, 1 low viral load patient with fever and diarrhea, 5 with continuous low viral load. Only 4 patients received antiviral therapy after the fourth positivity of >5×10(3) copies/ml. In the study group, 35 cases received ganciclovir and 6 cases received foscarnet. The incidence of neutropenia did not differ significantly between study and control groups [minimum of neutrophil count: (1.63±0.41)×10(9)/L vs. (1.58±0.36)×10(9)/L]. The proportion of viral load greater than 5×10(3) copies/ml in the first week was comparable in two groups. Successful viral clearance rate was not statistically different (=0.87). Of all 95 patients, no CMV diseases developed, neither did patient die of CMV infection. Spontaneous clearance of viremia occurs in some patients receiving allo-HSCT with low CMV viral load. Delayed antiviral treatment of continuous positive viremia does not prolong the whole treatment duration, neither contributes to the progression of CMV diseases.
探讨异基因造血干细胞移植（allo-HSCT）患者抢先抗病毒治疗的巨细胞病毒（CMV）血症阈值。通过实时定量聚合酶链反应将病毒载量在1×10³拷贝/毫升至5×10³拷贝/毫升之间定义为低病毒载量。收集临床数据和结果。本研究纳入了2014年9月至2015年2月期间95例低病毒载量的allo-HSCT受者。对照组包括37例接受抢先初始抗病毒治疗的患者。另外58例患者在确认病毒血症阳性后未接受抗病毒治疗。在监测期间，研究组17例患者的CMV病毒血症自发清除。研究组中41例病毒血症持续阳性的患者中，26例在第二次病毒血症阳性后接受抗病毒治疗，其中18例病毒载量>5×10³拷贝/毫升，2例发热但病毒载量仍低，2例有出血性膀胱炎且病毒载量低，4例病毒载量持续低。11例患者在第三次病毒血症阳性后接受抗病毒治疗，其中5例病毒载量>5×10³拷贝/毫升，1例病毒载量低且发热腹泻，5例病毒载量持续低。仅4例病毒载量>5×10³拷贝/毫升的患者在第四次病毒血症阳性后接受抗病毒治疗。研究组中，35例接受更昔洛韦治疗，6例接受膦甲酸钠治疗。研究组和对照组中性粒细胞减少的发生率无显著差异[中性粒细胞计数最低值：（1.63±0.41）×10⁹/L对（1.58±0.36）×10⁹/L]。两组在第一周病毒载量大于5×10³拷贝/毫升的比例相当。病毒清除成功率无统计学差异（=0.87）。在所有95例患者中，均未发生CMV疾病，也没有患者死于CMV感染。一些接受低CMV病毒载量allo-HSCT的患者会出现病毒血症的自发清除。对持续阳性病毒血症的延迟抗病毒治疗不会延长整个治疗时间，也不会导致CMV疾病进展。
