Ippoliti C, Morgan A, Warkentin D, van Besien K, Mehra R, Khouri I, Giralt S, Gajewski J, Champlin R, Andersson B, Przepiorka D
Section of Blood and Marrow Transplantation, UT MD Anderson Cancer Center, Houston 77030, USA.
Bone Marrow Transplant. 1997 Sep;20(6):491-5. doi: 10.1038/sj.bmt.1700910.
Cytomegalovirus (CMV) disease can be prevented by administration of ganciclovir prophylactically post-transplant. However, up to 30% of patients discontinue use of ganciclovir as a result of profound neutropenia and may subsequently develop CMV infections while unprotected. To prevent reactivation of CMV, we administered foscarnet to 39 adults unable to receive ganciclovir due to delayed engraftment or ganciclovir-induced neutropenia. Twenty-four (62%) of the patients had received T cell-depleted marrow transplants. Foscarnet sodium 60 mg/kg i.v. daily was continued until the neutropenia resolved, at which time ganciclovir was resumed. CMV prophylaxis commenced at a median of 28 days following transplantation. Median time to initiation of foscarnet was day 60 post-transplant, and the median duration of treatment was 22 days. Foscarnet was well-tolerated. Six (15%) patients had CMV detected while receiving prophylaxis, and CMV-related mortality was 5%. Foscarnet is a safe and effective agent for prevention of CMV disease in allogeneic transplant recipients unable to receive ganciclovir.
巨细胞病毒（CMV）疾病可通过移植后预防性给予更昔洛韦来预防。然而，高达30%的患者因严重中性粒细胞减少而停止使用更昔洛韦，随后可能在无保护的情况下发生CMV感染。为预防CMV再激活，我们对39名因移植延迟或更昔洛韦诱导的中性粒细胞减少而无法接受更昔洛韦的成年人给予了膦甲酸钠。其中24名（62%）患者接受了T细胞去除的骨髓移植。每天静脉注射60mg/kg膦甲酸钠，持续至中性粒细胞减少症缓解，此时恢复使用更昔洛韦。CMV预防在移植后中位数28天开始。开始使用膦甲酸钠的中位时间为移植后第60天，中位治疗持续时间为22天。膦甲酸钠耐受性良好。6名（15%）患者在接受预防期间检测到CMV，CMV相关死亡率为5%。对于无法接受更昔洛韦的异基因移植受者，膦甲酸钠是预防CMV疾病的一种安全有效的药物。
