单倍型异基因造血干细胞移植后发生巨细胞病毒感染的临床分析

目的 探讨单倍型异基因造血干细胞移植后发生巨细胞病毒(CMV)感染的临床特点及治疗.方法 对北京军区总医院血液科2011年1月-2013年1月采用单倍型异基因造血干细胞移植治疗的50例患者的临床资料进行回顾性研究,供者接受粒细胞集落刺激因子动员,采用骨髓加外周血干细胞联合移植,预处理方案以改良BUCY方案为主,移植后监测CMV-DNA,分析CMV感染的特点并探讨其治疗方法.结果 全部患者中男32例,女18例,年龄5-45岁,平均年龄23.8岁,其中共12例发生CMV血症,发生率为24％,首次检出CMV-DNA中位时间是移植后50天(36-72),CMV定量范围为2.4×103-6.2×106拷贝/mL,其中6例为CMV相关性出血性膀胱炎,2例为CMV相关性间质性肺炎,抗CMV治疗后全部患者CMV-DNA转阴.结论 单倍型异基因造血干细胞移植后巨细胞病毒感染发生率高,更昔洛韦、膦甲酸钠抗病毒治疗疗效可靠、不良反应少.

Clinical analysis of cytomegalovirus infectious after haplotype allogeneic hematopoietic stem cell transplantation

Objective To explore the clinical characteristics and treatment of cytomegalovirus (CMV) infections after haplotype allogeneic hematopoietic stem cell transplantation.Methods A retrospective study was carried out on the clinical data of 50 patients with haplotype allogeneic hematopoietic stem cell transplantation from January 2011 to January 2013 in the Department of Hematology,General Hospital of Beijing Military Region.The donors were treated with granulocyte colony-stimulating factor.The combined bone marrow and peripheral blood stem cell transplantation were performed.The modified BUCY scheme was selected for the pretreatment process.CMV-DNA was tested after transplantation.The characteristics and treatment of cytomegalovirus infections were studied.Results The patients included 32 males,18 females.Their ages ranged from 5 to 45 years old with an average value of 23.8.CMV infection occurred in 12 cases,and the incidence rate was 24％.The median time of the first detection of CMV-DNA was 50 (36 to 72)days after transplantation,and the CMV DNA quantification range was 2.4 × 103-6.2 × 106 copies/mL.CMV-related hemorrhagic cystitis occurred in 6 cases and CMV-related interstitial pneumonia occurred in 2 cases.CMV-DNA became negative after anti-CMV treatment in all patients.Conclusions The prevalence of CMV infection was high in patients with haplotype allogeneic stem cell transplantation.The antiviral treatment with ganciclovir and foscarnet sodium was reliable and with fewer adverse reactions.