Hiemenz J W, Greene J N
Division of Bone Marrow Transplantation, H. Lee Moffitt Cancer Center, University of South Florida, Tampa.
Hematol Oncol Clin North Am. 1993 Oct;7(5):961-1002.
Improvements in the diagnosis, treatment, and prevention of infectious complications of bone marrow transplantation over the past two decades have markedly reduced the morbidity and mortality of this procedure. We are now able to begin early empiric antibiotic coverage with less toxic, but equally effective, antibacterial agents. Once believed to be uniformly fatal, complications such as CMV pneumonia are now considered treatable in at least half the cases with a combination of intravenous immunoglobulin and ganciclovir. Although probably the most controversial, prophylactic therapy has improved the outcome of patients undergoing bone marrow transplantation. The appropriate setting, agents to use, dose, and dose intervals will require further study in coming years. In the introduction to this article, we attempted to outline what is known about the immunobiology of bone marrow transplantation. A clear understanding of this process helps us recognize and anticipate the infectious complications encountered in this population of patients. It may also allow clinicians to focus more on immune augmentation as a means of prevention, as has been attempted with the newly available cytokines and the use of intravenous immunoglobulin infusions. Despite improvements in diagnosis, treatment, and prevention, infectious complications remain the leading cause of morbidity and mortality in the patient undergoing bone marrow transplantation. Future studies are required in this area to build on the successes of the last two decades.
在过去二十年中，骨髓移植感染并发症的诊断、治疗和预防方面的进展显著降低了该手术的发病率和死亡率。我们现在能够使用毒性较小但同样有效的抗菌药物开始早期经验性抗生素覆盖。曾经被认为一律致命的并发症，如巨细胞病毒肺炎，现在至少有一半的病例可通过静脉注射免疫球蛋白和更昔洛韦联合治疗。尽管预防性治疗可能是最具争议的，但它改善了接受骨髓移植患者的预后。在未来几年，合适的治疗环境、使用的药物、剂量和给药间隔仍需进一步研究。在本文的引言中，我们试图概述关于骨髓移植免疫生物学的已知情况。对这一过程的清晰理解有助于我们识别和预测该类患者中遇到的感染并发症。这也可能使临床医生更多地关注免疫增强作为一种预防手段，就像使用新出现的细胞因子和静脉注射免疫球蛋白输注所尝试的那样。尽管在诊断、治疗和预防方面有所改善，但感染并发症仍然是接受骨髓移植患者发病和死亡的主要原因。该领域未来的研究需要在前二十年成功的基础上继续推进。
