Bacigalupo A, Tedone E, Van Lint M T, Trespi G, Lonngren M, Sanna M A, Moro F, Frassoni F, Occhini D, Gualandi F
Divisione Ematologia II, Ospedale San Martino, Genova, Italy.
Bone Marrow Transplant. 1994 Jun;13(6):783-8.
Eleven patients underwent bone marrow transplant (BMT) from an HLA-identical sibling following single dose total body irradiation (TBI), with in vivo and ex vivo T cell depletion (TCD). In spite of CMV prophylaxis with acyclovir and high-dose i.v. Ig, 10 of 11 patients developed CMV antigenemia, at a median interval from BMT of 34 days (range 16-72 days) and five died with CMV disease. Foscarnet was then given prophylactically in 11 additional TCD patients to test whether we could (1) prevent CMV reactivation, and (2) reduce transplant-related mortality. Foscarnet was given daily from days +10 to +15 (180 mg/kg/day), then thrice weekly (90 mg/kg/day) until day +100. Five patients developed CMV antigenemia at a median interval from BMT of 42 days (range 16-65 days); one progressed to CMV pneumonitis and died. The risk of developing CMV antigenemia within day 100 is currently 91% for the historical control group and 45% for the foscarnet group (p = 0.005). At diagnosis of CMV, the median number of CMV antigen-positive cells was 6.5 (range 1-13) vs 1 (range 1-5) in acyclovir vs foscarnet patients (p = 0.02) and the median highest number of CMV antigen-positive cells was 7 (range 3-110) vs 1 (range 1-12), respectively, (p = 0.03). The actuarial 1 year transplant-related mortality (TRM) is 49% and 13% in the two groups (p = 0.08). This study suggests that foscarnet prophylaxis starting on day +10 post-BMT may be helpful in reducing the risk of CMV disease and early mortality following TCD BMT.
11名患者在接受单剂量全身照射（TBI）后，接受了来自 HLA 相同同胞的骨髓移植（BMT），并进行了体内和体外 T 细胞清除（TCD）。尽管使用阿昔洛韦和大剂量静脉注射免疫球蛋白（i.v. Ig）进行了巨细胞病毒（CMV）预防，但11名患者中有10名出现了 CMV 抗原血症，从 BMT 开始的中位间隔时间为34天（范围16 - 72天），5名患者死于 CMV 疾病。随后，在另外11名进行 TCD 的患者中预防性给予膦甲酸钠，以测试我们是否能够（1）预防 CMV 再激活，以及（2）降低移植相关死亡率。膦甲酸钠从第 +10天至 +15天每天给药（180 mg/kg/天），然后每周三次（90 mg/kg/天）直至第 +100天。5名患者出现 CMV 抗原血症，从 BMT 开始的中位间隔时间为42天（范围16 - 65天）；1名患者进展为 CMV 肺炎并死亡。历史对照组在100天内发生 CMV 抗原血症的风险目前为91%，膦甲酸钠组为45%（p = 0.005）。在诊断出 CMV 时，阿昔洛韦组与膦甲酸钠组中 CMV 抗原阳性细胞的中位数分别为6.5（范围1 - 13）对1（范围1 - 5）（p = 0.02），CMV 抗原阳性细胞的最高中位数分别为7（范围3 - 110）对1（范围1 - 12）（p = 0.03）。两组的1年移植相关死亡率（TRM）精算值分别为49%和13%（p = 0.08）。这项研究表明，BMT 后第 +10天开始的膦甲酸钠预防可能有助于降低 TCD BMT 后 CMV 疾病的风险和早期死亡率。
