Funada H, Harada M, Yoshida T, Hattori K
Jpn J Clin Oncol. 1984 Dec;14 Suppl 1:519-30.
Interstitial pneumonia, especially that due to cytomegalovirus (CMV), is a frequent and serious complication of allogeneic bone marrow transplantation (BMT). The influence of allogeneic BMT on the development of CMV pneumonia was investigated in comparison with that of autologous BMT. Data on 37 patients (23 allotransplants and 14 autotransplants) who survived for longer than one month were reviewed. All were conditioned for the transplant with marrow-lethal cytoreductive therapy. Interstitial pneumonia occurred in 15 allotransplant patients (65%) and in five autotransplant patients (36%), and was fatal in 10 allotransplant patients (67%) and in two autotransplant patients (40%), with no statistically significant difference between the two groups of patients. However, the high incidence of CMV pneumonia in allotransplant patients presented a striking contrast to that in autotransplant patients (13 of 23 versus one of 14, p less than 0.01). CMV pneumonia was closely associated with the occurrence of graft-versus-host disease (GVHD). Moreover, the data inferred that both delayed posttransplant immunologic recovery and numerous transfusions of blood products from multiple random donors predispose allotransplant patients to CMV pneumonia. Though combination therapy with acyclovir, interferon-alpha (IFN) and prednisolone seemed to be somewhat effective further studies are needed to verify its benefit considering that all the patients (five allotransplants and one autotransplant) who survived CMV pneumonia showed a significant seroconversion to CMV. On the other hand, neither IFN nor nonspecific gamma-globulin proved to be effective in preventing CMV pneumonia. It is thus suggested that special attention be focused not only on the development of better methods to prevent GVHD and improve posttransplant immunologic recovery but also on reduced exposure to exogenous CMV.
间质性肺炎，尤其是由巨细胞病毒（CMV）引起的间质性肺炎，是异基因骨髓移植（BMT）常见且严重的并发症。将异基因BMT与自体BMT对CMV肺炎发生发展的影响进行了比较研究。回顾了37例存活超过1个月的患者（23例异基因移植和14例自体移植）的数据。所有患者均接受了骨髓致死性细胞减灭疗法预处理。15例异基因移植患者（65%）和5例自体移植患者（36%）发生了间质性肺炎，10例异基因移植患者（67%）和2例自体移植患者（40%）死于间质性肺炎，两组患者之间无统计学显著差异。然而，异基因移植患者中CMV肺炎的高发病率与自体移植患者形成了鲜明对比（23例中的13例与14例中的1例，p<0.01）。CMV肺炎与移植物抗宿主病（GVHD）的发生密切相关。此外，数据推断移植后免疫恢复延迟以及多次输注来自多个随机供体的血液制品使异基因移植患者易患CMV肺炎。虽然阿昔洛韦、α干扰素（IFN）和泼尼松龙联合治疗似乎有一定效果，但鉴于所有存活CMV肺炎的患者（5例异基因移植和1例自体移植）均出现了CMV血清学显著转换，仍需要进一步研究来证实其益处。另一方面，IFN和非特异性γ球蛋白均未被证明对预防CMV肺炎有效。因此，建议不仅要特别关注开发更好的预防GVHD和改善移植后免疫恢复的方法，还要减少外源性CMV暴露。
