Okamoto T, Okada M, Mori A, Saheki K, Takatsuka H, Wada H, Tamura A, Fujimori Y, Takemoto Y, Kanamaru A, Kakishita E
Second Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Bone Marrow Transplant. 1997 Nov;20(9):801-3. doi: 10.1038/sj.bmt.1700967.
A female patient with ALL received a bone marrow transplant (BMT) from an unrelated donor with a one locus HLA mismatch. The donor was heterozygous at the HLA-A locus, while the patient was homozygous at this locus. The patient had cytomegalovirus (CMV) antigenemia on day 42 following an intensive preparative regimen that included anti-thymocyte globulin and BU+CY+TBI to prevent graft rejection. Ganciclovir was given initially for the treatment of CMV antigenemia, although the patient soon developed severe myelosuppression. The patient's hematopoietic recovery was poor, and CMV and human herpesvirus-6 (HHV-6) were detectable in the peripheral blood. Severe CMV retinitis was treated with foscarnet and the intraocular injection of ganciclovir. The CMV retinitis improved and the marrow gradually recovered. CMV and HHV-6 were no longer detectable in the peripheral blood. Foscarnet and intraocular injection of ganciclovir appeared to be an effective treatment for CMV retinitis in this myelosuppressed BMT patient.
一名急性淋巴细胞白血病（ALL）女性患者接受了来自一位HLA一个位点不匹配的无关供者的骨髓移植（BMT）。供者在HLA - A位点为杂合子，而患者在该位点为纯合子。在采用包括抗胸腺细胞球蛋白以及白消安（BU）+环磷酰胺（CY）+全身照射（TBI）的强化预处理方案以预防移植物排斥反应后的第42天，患者出现了巨细胞病毒（CMV）抗原血症。最初给予更昔洛韦治疗CMV抗原血症，尽管患者很快出现了严重的骨髓抑制。患者的造血恢复较差，外周血中可检测到CMV和人类疱疹病毒6型（HHV - 6）。采用膦甲酸钠和眼内注射更昔洛韦治疗严重的CMV视网膜炎。CMV视网膜炎有所改善，骨髓也逐渐恢复。外周血中不再能检测到CMV和HHV - 6。对于这位骨髓抑制的BMT患者，膦甲酸钠和眼内注射更昔洛韦似乎是治疗CMV视网膜炎的有效方法。
