Goodrich J M, Boeckh M, Bowden R
M. D. Anderson Cancer Center, University of Texas, Houston.
Clin Infect Dis. 1994 Aug;19(2):287-98. doi: 10.1093/clinids/19.2.287.
The purposes of this review are to examine the epidemiology of disease due to cytomegalovirus (CMV) in recipients of autologous and allogeneic marrow transplants and to compare different antiviral regimens used for the prevention of such disease in recipients of allogeneic marrow transplants, with an emphasis on ganciclovir. In seven studies, ganciclovir reduced the incidence of CMV infection and disease after allogeneic marrow transplantation. In one study mortality after transplantation was reduced because of a decreased rate of CMV-related death among ganciclovir-treated patients. Ganciclovir was effective when given to all CMV-seropositive patients (prophylaxis) or to patients who were considered at high risk for CMV disease on the basis of a positive surveillance culture (early treatment). The effectiveness of ganciclovir for the prevention of CMV infection and disease is limited by drug-induced neutropenia. Experience with other antiviral agents, such as foscarnet, has been limited. Initial studies of the adoptive transfer of CMV-specific CD8+ cytotoxic T cells have been conducted. In short, ganciclovir is currently effective for the prevention of CMV disease in allogeneic marrow transplant recipients, but its usefulness is limited by neutropenia. Future studies must be aimed at confining the toxicity of ganciclovir to patients at the highest risk for CMV disease.
本综述的目的是研究巨细胞病毒（CMV）所致疾病在自体和异基因骨髓移植受者中的流行病学，并比较用于预防异基因骨髓移植受者此类疾病的不同抗病毒方案，重点是更昔洛韦。在七项研究中，更昔洛韦降低了异基因骨髓移植后CMV感染和疾病的发生率。在一项研究中，由于更昔洛韦治疗的患者中CMV相关死亡发生率降低，移植后的死亡率也有所降低。当给予所有CMV血清学阳性患者（预防性用药）或根据监测培养阳性被认为有CMV疾病高风险的患者（早期治疗）时，更昔洛韦是有效的。更昔洛韦预防CMV感染和疾病的有效性受到药物诱导的中性粒细胞减少的限制。对其他抗病毒药物，如膦甲酸钠的经验有限。已经开展了CMV特异性CD8+细胞毒性T细胞过继转移的初步研究。简而言之，更昔洛韦目前对预防异基因骨髓移植受者的CMV疾病有效，但其效用受到中性粒细胞减少的限制。未来的研究必须旨在将更昔洛韦的毒性局限于CMV疾病风险最高的患者。
