Bacigalupo A, Bregante S, Tedone E, Isaza A, Van Lint M T, Moro F, Trespi G, Occhini D, Gualandi F, Lamparelli T, Marmont A M
Divisione Ematologia II, Ospedale San Martino, Genova.
Bone Marrow Transplant. 1996 Nov;18 Suppl 2:110-4.
Thirty two allogeneic bone marrow transplant (BMT) recipients, aged 16-55 (median 35), with CMV antigenemia (= > 5 positive cells) developing at a median interval from BMT of 49 days, were given combined treatment with foscarnet and ganciclovir for 15 days. Maintenance was given with foscarnet and ganciclovir on alternate days for an additional 2 weeks. 31/32 patients were on cyclosporin 30 on systemic antibiotics and 9 were on intravenous amphotericin Median laboratory values on day 1 and 15 of treatment were respectively creatinine 1.0-1.1 mg%; WBC 5.7-4.1 x 10(9)/l; platelets 78 72 x 10(9)/l. All patients cleared CMV-antigenemia by day +15, though 5 reactivated on and 14 off maintenance: the dose of foscarnet (but not ganciclovir) received in the first 15 days was significantly lower in patients reactivating within 30 days (p = 0.0002). Six patients died, one with i.p., one with multiorgan failure, and four with infections. Eighteen patients survive 119-1051 days post-transplant. The actuarial TRM at 1 year is 23%. This study shows that combined foscarnet-ganciclovir is one therapeutic option for allogeneic BMT recipients developing CMVAg-emia with a high number of CMVAg+ cells: treatment can be given together with cyclosporin and antibiotics with appropriate dose reductions; it produces prompt clearing of CMV infection, and may reduce transplant related mortality when compared to single agent therapy.
32名年龄在16 - 55岁（中位数35岁）的异基因骨髓移植（BMT）受者，在BMT后中位间隔49天出现巨细胞病毒血症（= > 5个阳性细胞），接受了膦甲酸钠和更昔洛韦联合治疗15天。之后交替给予膦甲酸钠和更昔洛韦维持治疗2周。32例患者中有31例使用环孢素，30例使用全身抗生素，9例使用静脉注射两性霉素。治疗第1天和第15天的中位实验室值分别为：肌酐1.0 - 1.1mg%；白细胞5.7 - 4.1×10⁹/L；血小板78 - 72×10⁹/L。所有患者在第15天时巨细胞病毒血症均清除，尽管5例在维持治疗时复发，14例未复发：在30天内复发的患者在最初15天接受的膦甲酸钠（而非更昔洛韦）剂量显著较低（p = 0.0002）。6例患者死亡，1例死于腹腔内感染，1例死于多器官功能衰竭，4例死于感染。18例患者在移植后存活119 - 1051天。1年时的实际移植相关死亡率为23%。本研究表明，膦甲酸钠 - 更昔洛韦联合治疗是异基因BMT受者出现大量巨细胞病毒抗原阳性细胞的巨细胞病毒血症的一种治疗选择：治疗可与环孢素和抗生素联合使用，并适当减少剂量；它能迅速清除巨细胞病毒感染，与单药治疗相比，可能降低移植相关死亡率。
