Bacigalupo A, van Lint M T, Tedone E, Moro F, Sanna M A, Longren M, Trespi G, Frassoni F, Occhini D, Gualandi F
Divisione Ematologia II, Ospedale San Martino, Genova, Italy.
Bone Marrow Transplant. 1994 Jun;13(6):753-8.
Twenty-five patients with hematologic malignancies (n = 21) or aplastic anemia (n = 4) undergoing an allogeneic BMT from an HLA-identical sibling developed cytomegalovirus (CMV) antigenemia at a mean interval from BMT of 41 days (range 16-141 days). All patients were treated at the time of antigenemia in the absence of other signs of CMV disease with ganciclovir (n = 13) or foscarnet (n = 12) if the WBC count was < 2.5 x 10(9)/l or the patient had aplastic anemia. The two groups were comparable for age, sex and disease status. There were more patients receiving T cell-depleted grafts in the foscarnet group (58% vs 15%, p = 0.003). The first course of treatment was planned to last a minimum of 10 days: foscarnet was given at 180 mg/kg/day, and ganciclovir at 10 mg/kg/day. Patients still showing pp65-positive cells continued treatment in the absence of adverse effects such as cytopenia and/or increased creatinine levels. Maintenance treatment was given for 3-4 weeks. End-points of the study were (1) clearing of CMV antigenemia, (2) tolerance and side-effects, and (3) progression to CMV disease. Both agents were effective in clearing CMV antigenemia: 14 of 25 patients were CMV antigen-negative by day 14 of treatment and all surviving patients were negative by day +50. Renal toxicity was seen mainly in the foscarnet group but caused discontinuation of the drug only in one patient. Myelotoxicity was seen in the ganciclovir group and again could be controlled in 12 of 13 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
25例接受来自 HLA 相同同胞的异基因骨髓移植（BMT）的血液系统恶性肿瘤患者（n = 21）或再生障碍性贫血患者（n = 4），在 BMT 后平均41天（范围16 - 141天）出现巨细胞病毒（CMV）抗原血症。所有患者在抗原血症出现时接受治疗，若白细胞计数<2.5×10⁹/L 或患者患有再生障碍性贫血，则在无其他 CMV 疾病体征时使用更昔洛韦（n = 13）或膦甲酸钠（n = 12）治疗。两组在年龄、性别和疾病状态方面具有可比性。膦甲酸钠组接受 T 细胞去除移植物的患者更多（58%对15%，p = 0.003）。首个疗程计划至少持续10天：膦甲酸钠剂量为180mg/kg/天，更昔洛韦为10mg/kg/天。仍显示 pp65 阳性细胞的患者在无血细胞减少和/或肌酐水平升高等不良反应时继续治疗。维持治疗持续3 - 4周。研究终点为：（1）CMV 抗原血症清除；（2）耐受性和副作用；（3）进展为 CMV 疾病。两种药物在清除 CMV 抗原血症方面均有效：25例患者中有14例在治疗第14天时 CMV 抗原呈阴性，所有存活患者在第 +50天时均为阴性。肾毒性主要见于膦甲酸钠组，但仅1例患者因该毒性停药。更昔洛韦组出现骨髓毒性，13例患者中有12例的该毒性可得到控制。（摘要截短至250字）
