Wingard J R
Bone Marrow Transplant Program, Emory University School of Medicine, Atlanta, Georgia 30322.
Leuk Lymphoma. 1993;11 Suppl 2:115-25. doi: 10.3109/10428199309064271.
Infections by herpesviruses are common phenomena in patients being treated for acute leukemia and those undergoing bone marrow transplantation. Reactivation of endogenous latent virus caused by the immunosuppressive and cytotoxic effects of cytoreductive therapies is a common mechanism of infection. With cytomegalovirus (CMV), acquisition of exogenous virus by transfusion of blood products containing virus and from the bone marrow graft in the case of bone marrow transplantation can occur. Serious morbidity can result and occasional mortality. CMV infections in allogeneic BMT recipients have high case fatality rates. Treatment and preventive strategies for herpes simplex virus (HSV), CMV, and varicella zoster virus (VZV) have been developed to reduce morbidity. Acyclovir, either given prophylactically or as treatment of active infection, has been highly successful in reducing illness from HSV and VZV infection. For CMV, provision of CMV-seronegative blood products is the mainstay of prevention of morbidity in seronegative patients and is especially important in the care of patients undergoing allogeneic BMT. Ganciclovir given either prophylactically or as early therapy for patients detected to be shedding CMV appears to be a promising strategy. Bolstering host immunity through augmentation of anti-CMV cytotoxic T-cell responses appears to be an exciting candidate therapy under development.
疱疹病毒感染在接受急性白血病治疗的患者以及接受骨髓移植的患者中是常见现象。细胞减灭疗法的免疫抑制和细胞毒性作用导致内源性潜伏病毒重新激活是常见的感染机制。对于巨细胞病毒（CMV），通过输注含有病毒的血液制品以及在骨髓移植情况下从骨髓移植物中获取外源性病毒是可能发生的。这可能导致严重的发病情况，偶尔还会导致死亡。异基因骨髓移植受者中的CMV感染具有较高的病死率。已经制定了针对单纯疱疹病毒（HSV）、CMV和水痘带状疱疹病毒（VZV）的治疗和预防策略以降低发病率。阿昔洛韦无论是预防性给药还是用于治疗活动性感染，在减轻HSV和VZV感染所致疾病方面都非常成功。对于CMV，提供CMV血清阴性的血液制品是预防血清阴性患者发病的主要手段，在照顾接受异基因骨髓移植的患者中尤为重要。对于检测到正在排出CMV的患者，预防性给予更昔洛韦或作为早期治疗似乎是一种有前景的策略。通过增强抗CMV细胞毒性T细胞反应来增强宿主免疫力似乎是正在开发的一种令人兴奋的候选疗法。
