Koehler M, St George K, Ehrlich G D, Mirro J, Neudorf S M, Rinaldo C
University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, PA 15213-2583, U.S.A.
J Pediatr Hematol Oncol. 1997 Jan-Feb;19(1):43-7. doi: 10.1097/00043426-199701000-00006.
Cytomegalovirus (CMV) infection can cause severe disease and mortality in recipients of allogeneic bone marrow transplants (alloBMT) when either the donor or recipient is CMV seropositive (high-risk alloBMT). We investigated the efficacy of preemptive therapy guided by detection of CMV antigenemia.
In 11 high-risk alloBMT recipients, high-dose ganciclovir (GCV) treatment was initiated at first positive antigenemia and was continued until antigenemia became negative.
The treatment strategy prevented CMV disease during the follow-up period of the study in 7 alloBMT recipients with positive CMV antigenemia. Three other patients who were shown to be CMV antigenemia negative but positive for CMV DNA in blood by the polymerase chain reaction (PCR) were not treated and did not develop CMV disease. The eleventh patient was negative for CMV by all tests for the duration of the study and did not develop CMV disease.
We have found antigenemia-guided preemptive GCV therapy to be an effective strategy for the prevention of CMV disease in high-risk alloBMT recipients.
当供体或受体巨细胞病毒血清学呈阳性时（高危异基因骨髓移植），巨细胞病毒（CMV）感染可导致异基因骨髓移植（alloBMT）受者出现严重疾病和死亡。我们研究了以检测CMV抗原血症为指导的抢先治疗的疗效。
对11例高危alloBMT受者，在首次抗原血症呈阳性时开始高剂量更昔洛韦（GCV）治疗，并持续至抗原血症转阴。
在研究的随访期内，该治疗策略预防了7例CMV抗原血症阳性的alloBMT受者发生CMV疾病。另外3例经聚合酶链反应（PCR）检测显示CMV抗原血症阴性但血液中CMV DNA阳性的患者未接受治疗，也未发生CMV疾病。第11例患者在研究期间所有检测均显示CMV阴性，未发生CMV疾病。
我们发现以抗原血症为指导的抢先GCV治疗是预防高危alloBMT受者发生CMV疾病的有效策略。
