Current antiviral strategies for controlling cytomegalovirus in hematopoietic stem cell transplant recipients: prevention and therapy

Cytomegalovirus (CMV) remains a cause of significant morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Ganciclovir prophylaxis, or preemptive treatment based on detection of antigenemia or CMV DNA by PCR, effectively prevents CMV disease during the first 100 days after transplant in allograft recipients. In recipients of T-cell depleted transplant or if severe acute graft-versus-host disease is present, ganciclovir prophylaxis or preemptive treatment should be started with an induction course of ganciclovir (5 mg/kg BID) and given at least 5 days per week and continued until day 100 after transplant. Although prevention of CMV disease before day 100 is highly effective, there is a continued risk of late-onset CMV disease after day 100. In CMV-seropositive recipients, the incidence of late CMV disease may be as high as 17%. Strategies to prevent late CMV infection and disease are needed. In seronegative recipients, seronegative or leukocyte-reduced blood products are effective in preventing acquisition of CMV through blood products. Controversy exists about the optimal strategy of preventing CMV disease in seropositive autologous HSCT recipients. The outcome of CMV pneumonia remains poor despite treatment with ganciclovir in combination with CMV hyperimmune globulin or intravenous immunoglobulin. Owing to continued clinical significance of CMV in the HSCT setting, new and more effective anti-CMV drugs with improved pharmacokinetic properties are urgently needed.     

Extended routine polymerase chain reaction surveillance and pre-emptive antiviral therapy for cytomegalovirus after allogeneic transplantation

Pre-emptive treatment strategies based on sensitive screening for cytomegalovirus (CMV) infection up to day +100 after allogeneic transplantation have been shown to reduce the incidence of CMV disease during the period of surveillance. However, the use of ganciclovir has been associated with delays in immune reconstitution and an increased incidence of late CMV disease after day +100. In the present study, 81 patients undergoing allogeneic transplantation received polymerase chain reaction (PCR)-guided pre-emptive therapy based on detection of CMV DNA by PCR on 2 consecutive weeks up to day +180. Thirty-three of the 52 high-risk patients (CMV-seropositive donor or recipient) received a total of 45 treatment episodes up to day +100. Three of these patients (5.7%) developed CMV disease, with one fatality. Twelve of the surviving 44 high-risk patients (27%) required pre-emptive treatment between days +101 and +192, but none of these patients developed late CMV disease with a median follow-up of 402 d (range 117-952 d). Antiviral therapy was stopped after a single negative PCR result with no subsequent episodes of CMV disease while patients remained off antiviral treatment. As all initial episodes of CMV DNA detection occurred within 60 d of transplantation, it may be possible to discontinue monitoring beyond day +100 in patients who have remained CMV PCR negative before this. Thus, we have confirmed that PCR-guided pre-emptive therapy results in a low incidence of CMV disease before day +100 and that discontinuing treatment on the basis of viral clearance as determined by CMV PCR appears to be safe practice. In addition, we have observed no episodes of late CMV disease with an extension of surveillance to 26 weeks.     

Late cytomegalovirus disease and mortality in recipients of allogeneic hematopoietic stem cell transplants: importance of viral load and T-cell immunity

Ganciclovir effectively prevents cytomegalovirus (CMV) disease in the first 100 days after allogeneic hematopoietic stem cell transplantation (HSCT), but late-onset CMV disease is increasingly observed. We designed a prospective cohort study to define the incidence and risk factors for late CMV infection in patients who undergo HSCT. CMV-seropositive patients were studied prospectively for CMV infection (quantitative pp65 antigenemia, quantitative CMV-DNA, blood culture), T-cell immunity (CMV-specific CD4(+) T-helper and CD8(+) cytotoxic T-lymphocyte responses, CD4 and CD8 T-cell count, absolute lymphocyte count), and other transplantation-related factors. Univariate and multivariable analyses were used to assess the risk for late CMV infection and disease and to assess overall survival. Late CMV disease developed in 26 of 146 (17.8%) patients a median of 169 days after transplantation (range, 96-784 days); the mortality rate was 46%. Thirty-eight percent of patients surviving late disease had a second episode a median of 79 days after the first episode. At 3 months after transplantation, preceding detection of CMV pp65 antigenemia, CD4 T-cell counts lower than 50 cells/mm(3), postengraftment absolute lymphopenia levels lower than 100 lymphocytes/mm(3), undetectable CMV-specific T-cell responses, and graft-versus-host disease (GVHD) were associated with late CMV disease or death. After 3 months, continued detection of pp65 antigenemia or CMV DNA in plasma or peripheral blood leukocytes and lymphopenia (fewer than 300 lymphocytes/mm(3)) were strong predictors of late CMV disease and death. In conclusion, CMV viral load, lymphopenia, and CMV-specific T-cell immunodeficiency are predictors of late CMV disease and death after allogeneic stem cell transplantation. Prevention strategies should be targeted at patients in whom CMV reactivated during the first 3 months and those with poor CMV-specific immunity or low CD4 counts.     

Cytomegalovirus infection in heart-lung transplant recipients: risk factors, clinical associations, and response to treatment.

The risk factors, clinical associations, and response to treatment of cytomegalovirus (CMV) pneumonia and infection were studied in 65 recipients of heart-lung transplantation. There were 29 episodes of CMV pneumonia in 22 patients. In 80% (20/25) of episodes of CMV pneumonia treated with intravenous ganciclovir, the histologic changes resolved and the patient survived. Among seronegative recipients, a seropositive donor was a significant risk factor for CMV pneumonia and infection in the first 90 days after heart-lung transplantation (P = .004 and .002, respectively). Among seropositive recipients, there was no additional risk associated with a sero-positive donor. Rates of CMV pneumonia and infection were significantly increased when treatment with augmented immunosuppression had been given in the preceding 30 days (P less than .001). A significant association was found between CMV pneumonia or infection and pulmonary bacterial infections occurring 30 days before or after such an episode (P less than .001).     

Detection of cytomegalovirus infection with the polymerase chain reaction and antigenemia after allogenic bone marrow transplantation

The objective of the work was to evaluate the frequency and time of incidence of cytomegaloviral (CMV) infection and disease in patients after allogeneic bone marrow transplantation (BMT). One hundred patients were followed up (70 with a related and 30 with an unrelated donor), who had transplantations during the period between XI/1996-XI/2000. Methods used: nested-PCR (MIE-gene) and antigenaemia (antigen pp65). Active CMV infection was proved in antigenaemia > or = 5 positive cells or in two consecutive positive PCR. The CMV syndrome was assessed in confirmed CMV infection and otherwise inexplicable febrile conditions and/or a drop of haemogram values. For the diagnosis of CMV pneumonia the clinical picture was needed, evidence of active CMV infection and on the X-ray of the lungs interstitial pneumonia. In 33 patients both methods were used, in 67 only PCR. The first positive test appeared 6-321 days after BMT (median +/- 49 days). CMV infection was proved in 44% cases, CMV syndrome in 30% and CMV pneumonia in 4%. In patients with a related donor CMV infection was found in 34.3%, CMV syndrome in 22.9%, CMV pneumonia in 1.4%. After unrelated donor BMT CMV infection was recorded in 66.7%, CMV syndrome in 46.7% and CMV pneumonia in 10% patients. Two patients died from CMV pneumonia. CMV pneumonia was diagnosed 57-115 days after BMT (median +/- 68 days. The risk of CMV infection is high in both groups of patients, in particular in patients after unrelated donor BMT (66.7%). As far as the development of CMV pneumonia was concerned, the mortality in the authors' group was 50%.     

Bacterial pneumonia in solid organ transplantation

Approximately 4% of recipients of solid organ transplants in the United States develop bacterial pneumonia in the posttransplant period, often in the first 3 months following transplantation. The incidence of bacterial pneumonia is highest in recipients of heartlung (22%) and liver transplants (17%), intermediate in recipients of heart transplants (5%), and lowest in renal transplant patients (1 to 2%). The crude mortality of bacterial pneumonia in solid organ transplantation has exceeded 40% in most series. Beyond those risk factors identified for nosocomial pneumonia, the occurrence of primary cytomegalovirus (CMV) infection, graft rejection, maintenance antirejection therapy with prednisone, azathioprine, and antilymphocyte globulin, antirejection therapy with high-dose corticosteroids or OKT3 and splenectomy have been associated with a significantly increased risk of bacterial pneumonia in these patients. In the first 3 months posttransplant, gram-negative bacilli, Staphylococcus aureus and Legionella predominate and mortality is very high, in excess of 60%. Thereafter, bacterial pneumonias are caused primarily by Streptococcus pneumoniae and Hemophilus influenzae, with considerably lower mortality. Bacterial pneumonia must be suspected in any transplant patient presenting with fever and cough, especially associated with dyspnea or infiltrates on chest radiograph. If large numbers of bacteria and polymorphonuclear leukocytes are not visualized in respiratory secretions the work-up should proceed directly to fiberoptic bronchoscopy with bronchoalveolar lavage and/or protected brush specimen to establish the microbiologic diagnosis as accurately as possible. For presumptive gram-negative bacillary pneumonia, the initial regimen must be effective against Pseudomonas aeruginosa. Prevention of bacterial pneumonia in transplant patients must begin with immunization against S pneumoniae and Influenza A, and include precautions taken to prevent nosocomial pneumonia. It further may include measures to prevent CMV infection and the use of trimethoprim/sulfamethoxazole prophylaxis during the first year posttransplantation. Ultimately, novel technologies such as selective antimicrobial decontamination and/or protective isolation during the early postoperative period may prove effective.     

Cytomegalovirus as a cause of very late interstitial pneumonia after bone marrow transplantation

Cytomegalovirus (CMV) infection is an important cause of morbidity and mortality after allogeneic transplant. Interstitial pneumonia (IP) is the most common manifestation of CMV in BMT patients, with a 30-48% mortality rate despite adequate treatment. Most CMV infection occurs in the first 100 days. However, prolonged ganciclovir (GCV) prophylaxis has favored the occurrence of late CMV IP, probably by inhibition of the development of CMV-specific T cell lymphocyte responses. We report the case of a patient treated with an allogeneic BMT who received pre-emptive GCV until day +100 because of CMV-positive antigenemia. He developed a CMV IP on day +811 post BMT, which responded to treatment. We intend to alert clinicians that even at long-term (>1 year) post-BMT, CMV is a possible cause of IP in high-risk patients.     

Virological, clinical, and ophthalmologic features of cytomegalovirus retinitis after hematopoietic stem cell transplantation.

We identified 10 patients who developed cytomegalovirus (CMV) retinitis after HSCT during a 14-year period. The median day of diagnosis of CMV retinitis after transplantation was day 251 (range, days 106--365). CMV retinitis was associated with CMV serostatus of donor or recipient (P=0.01), CMV reactivation before day 100 (P=0.007), delayed lymphocyte engraftment (P<0.05), and chronic graft versus host disease (GVHD; P<0.001). In allogeneic recipients of HSCT who were alive at day 100 after transplantation and had chronic clinical extensive GVHD, the incidence of GVHD was 1.4% (8 of 577). Five of 10 patients had other manifestation of CMV disease before retinitis occurred (4 with gastrointestinal disease and 1 with interstitial pneumonia; median time, 70 days before onset of CMV retinitis; range, 58--279 days), and 4 others had CMV excretion. CMV retinitis was bilateral in 4 patients; 9 of 10 patients had ocular symptoms (i.e., decreased vision and floaters). Six of 7 patients responded well to ganciclovir or foscarnet systemic treatment, 1 improved only after switching to cidofovir, and 1 patient who received a transplant in 1983 did not respond to acyclovir treatment. In conclusion, CMV retinitis is an uncommon late complication after HSCT that occurs mainly in seropositive allograft recipients with previous CMV reactivation and chronic GVHD, and with delayed engraftment of lymphocytes.     

Allograft rejection predicts the occurrence of late-onset cytomegalovirus (CMV) disease among CMV-mismatched solid organ transplant patients receiving prophylaxis with oral ganciclovir.

The natural history of cytomegalovirus (CMV) disease associated with solid organ transplantation has been modified as a result of the widespread use of antiviral prophylaxis. Anecdotal reports have indicated a reduction of CMV disease at the expense of its later occurrence after completion of ganciclovir prophylaxis. The present study investigated the occurrence of CMV disease and its risk factors among 37 liver and kidney transplant recipients with CMV D+/R- status who received oral ganciclovir during the first 100 days posttransplantation. CMV disease occurred in 9 patients (24.3%) at a median of 144 days posttransplantation (range, 95-190 days). Allograft rejection was found to be strongly associated with the occurrence of late-onset CMV disease (risk ratio, 6.6; 95% confidence interval, 1.4-32.1; P=.02). Thus, CMV D+/R- solid organ transplant recipients receiving 3 months of oral ganciclovir who develop allograft rejection during the period of antiviral prophylaxis may benefit from extended and/or enhanced antiviral prophylaxis to prevent late-onset CMV disease.     

Clinical significance of post‐prophylaxis cytomegalovirus infection in lung transplant recipients

Cytomegalovirus (CMV ) disease has been associated with the development of chronic lung allograft dysfunction (CLAD ) after transplantation. However, the relevance of CMV replication occurring after the discontinuation of antiviral prophylaxis on the development of CLAD has not been fully established. Patients who underwent lung transplantation during 2004‐2014 were included. All patients received antiviral prophylaxis for 3‐6 months, followed by monitoring of CMV replication during the first year post‐transplantation (preemptive therapy). Risk factors for the development of CLAD were assessed by Cox models. A linear regression model with an interaction coefficient between time and CMV infection was used to evaluate the influence of CMV infection on the evolution of FEV ₁. Overall, 69 patients were included, 30/69 (43%) patients developed at least 1 episode of significant CMV infection, and 8/69 (11.5%) patients developed CMV disease. After a median follow‐up of 3.67 years, 25/69 (36%) patients developed CLAD and 14/69 (20%) patients died. In the univariate Cox analysis, significant CMV infection (HR 1.177, P  = .698), CMV disease (HR 1.001, P  = .998), and duration of CMV replication (HR 1.004, P  = .758) were not associated with CLAD . Only bacterial pneumonia tended to be associated with CLAD in the multivariate model (HR 2.579, P  = .062). We did not observe a significant interaction between CMV replication and evolution FEV ₁ (interaction coefficient 0.006, CI 95% [?0.084 to 0.096], P  = .890). In this cohort of lung transplant recipients receiving antiviral prophylaxis and monitored by preemptive therapy post‐prophylaxis, CMV infection did not have impact on long‐term allograft lung function.     

抢先治疗异基因造血干细胞移植后巨细胞病毒感染的临床分析

目的 回顾性分析抢先治疗异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)感染的临床意义.方法 allo-HSCT治疗的患者103例,采用荧光定量PCR法监测CMV-DNA,并根据其结果抢先治疗CMV相关疾病,分析抢先治疗对于阻止CMV血症发展为CMV相关疾病的意义.结果 103例患者中检测出63例次(51例)CMV-DNA阳性,CMV血症发生率为49.5%,经抢先治疗19例发生CMV相关疾病,发生率为18.4%.60例次CMV血症经更昔洛韦和(或)膦甲酸治疗转阴,1例不可评价疗效,治疗的总有效率为96.8%(60/62).CMV相关疾病的治疗总有效率为89.5%(17/19),2例患者因CMV相关肺炎伴急性GVHD而死亡,CMV相关疾病的直接死亡率为1.9%(2/103).结论 在不进行预防性治疗的前提下,CMV血症和CMV相关疾病发生率未见升高.抢先治疗能有效阻止大部分CMV血症患者发病,并能有效控制CMV相关疾病的进展.     

抢先治疗异基因造血干细胞移植后巨细胞病毒感染的临床分析

目的 回顾性分析抢先治疗异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)感染的临床意义.方法 allo-HSCT治疗的患者103例,采用荧光定量PCR法监测CMV-DNA,并根据其结果抢先治疗CMV相关疾病,分析抢先治疗对于阻止CMV血症发展为CMV相关疾病的意义.结果 103例患者中检测出63例次(51例)CMV-DNA阳性,CMV血症发生率为49.5%,经抢先治疗19例发生CMV相关疾病,发生率为18.4%.60例次CMV血症经更昔洛韦和(或)膦甲酸治疗转阴,1例不可评价疗效,治疗的总有效率为96.8%(60/62).CMV相关疾病的治疗总有效率为89.5%(17/19),2例患者因CMV相关肺炎伴急性GVHD而死亡,CMV相关疾病的直接死亡率为1.9%(2/103).结论 在不进行预防性治疗的前提下,CMV血症和CMV相关疾病发生率未见升高.抢先治疗能有效阻止大部分CMV血症患者发病,并能有效控制CMV相关疾病的进展.     

抢先治疗异基因造血干细胞移植后巨细胞病毒感染的临床分析

目的 回顾性分析抢先治疗异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)感染的临床意义.方法 allo-HSCT治疗的患者103例,采用荧光定量PCR法监测CMV-DNA,并根据其结果抢先治疗CMV相关疾病,分析抢先治疗对于阻止CMV血症发展为CMV相关疾病的意义.结果 103例患者中检测出63例次(51例)CMV-DNA阳性,CMV血症发生率为49.5%,经抢先治疗19例发生CMV相关疾病,发生率为18.4%.60例次CMV血症经更昔洛韦和(或)膦甲酸治疗转阴,1例不可评价疗效,治疗的总有效率为96.8%(60/62).CMV相关疾病的治疗总有效率为89.5%(17/19),2例患者因CMV相关肺炎伴急性GVHD而死亡,CMV相关疾病的直接死亡率为1.9%(2/103).结论 在不进行预防性治疗的前提下,CMV血症和CMV相关疾病发生率未见升高.抢先治疗能有效阻止大部分CMV血症患者发病,并能有效控制CMV相关疾病的进展.     

抢先治疗异基因造血干细胞移植后巨细胞病毒感染的临床分析

目的 回顾性分析抢先治疗异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)感染的临床意义.方法 allo-HSCT治疗的患者103例,采用荧光定量PCR法监测CMV-DNA,并根据其结果抢先治疗CMV相关疾病,分析抢先治疗对于阻止CMV血症发展为CMV相关疾病的意义.结果 103例患者中检测出63例次(51例)CMV-DNA阳性,CMV血症发生率为49.5%,经抢先治疗19例发生CMV相关疾病,发生率为18.4%.60例次CMV血症经更昔洛韦和(或)膦甲酸治疗转阴,1例不可评价疗效,治疗的总有效率为96.8%(60/62).CMV相关疾病的治疗总有效率为89.5%(17/19),2例患者因CMV相关肺炎伴急性GVHD而死亡,CMV相关疾病的直接死亡率为1.9%(2/103).结论 在不进行预防性治疗的前提下,CMV血症和CMV相关疾病发生率未见升高.抢先治疗能有效阻止大部分CMV血症患者发病,并能有效控制CMV相关疾病的进展.     

Two strategies for prevention of cytomegalovirus infections after liver transplantation

AIM: To analyze differences in patients' clinical course, we compared two regimes of either preemptive therapy or prophylaxis after liver transplantation.METHODS: This retrospective study was reviewed and approved by the institutional review board of the University of Leipzig. Cytomegalovirus(CMV) prophylaxis with valganciclovir hydrochloride for liver transplant recipients was replaced by a preemptive strategy in October 2009. We retrospectively compared liver transplant recipients 2 years before and after October 2009. During the first period, all patients received valganciclovir daily. During the second period all patients included in the analysis were treated following a preemptive strategy. Outcomes included one year survival and therapeutic intervention due to CMV viremia or infection.RESULTS: Between 2007 and 2010 n = 226 patients underwent liver transplantation in our center. n = 55 patients were D~+/R~- high risk recipients and were excluded from further analysis. A further 43 patients had to be excluded since CMV prophylaxis/preemptive strategy was not followed although there was no clinical reason for the deviation. Of the remaining 128 patients whose data were analyzed, 60 receivedprophylaxis and 68 were treated following a preemptive strategy. The difference in overall mortality was not significant, nor was it significant for one-year mortality where it was 10%(95%CI: 8%-28%, P = 0.31) higher for the preemptive group. No significant differences in blood count abnormalities or the incidence of sepsis and infections were observed other than CMV. In total, 19 patients(14.7%) received ganciclovir due to CMV viremia and/or infections. Patients who were treated according to the preemptive algorithm had a significantly higher rate risk of therapeutic intervention with ganciclovir [n = 16(23.5%) vs n = 3(4.9%), P = 0.003)].CONCLUSION: These data suggest that CMV prophylaxis is superior to a preemptive strategy in patients undergoing liver transplantation.     

抢先治疗异基因造血干细胞移植后巨细胞病毒感染的临床分析

目的 回顾性分析抢先治疗异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)感染的临床意义.方法 allo-HSCT治疗的患者103例,采用荧光定量PCR法监测CMV-DNA,并根据其结果抢先治疗CMV相关疾病,分析抢先治疗对于阻止CMV血症发展为CMV相关疾病的意义.结果 103例患者中检测出63例次(51例)CMV-DNA阳性,CMV血症发生率为49.5%,经抢先治疗19例发生CMV相关疾病,发生率为18.4%.60例次CMV血症经更昔洛韦和(或)膦甲酸治疗转阴,1例不可评价疗效,治疗的总有效率为96.8%(60/62).CMV相关疾病的治疗总有效率为89.5%(17/19),2例患者因CMV相关肺炎伴急性GVHD而死亡,CMV相关疾病的直接死亡率为1.9%(2/103).结论 在不进行预防性治疗的前提下,CMV血症和CMV相关疾病发生率未见升高.抢先治疗能有效阻止大部分CMV血症患者发病,并能有效控制CMV相关疾病的进展.     

抢先治疗异基因造血干细胞移植后巨细胞病毒感染的临床分析

目的 回顾性分析抢先治疗异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)感染的临床意义.方法 allo-HSCT治疗的患者103例,采用荧光定量PCR法监测CMV-DNA,并根据其结果抢先治疗CMV相关疾病,分析抢先治疗对于阻止CMV血症发展为CMV相关疾病的意义.结果 103例患者中检测出63例次(51例)CMV-DNA阳性,CMV血症发生率为49.5%,经抢先治疗19例发生CMV相关疾病,发生率为18.4%.60例次CMV血症经更昔洛韦和(或)膦甲酸治疗转阴,1例不可评价疗效,治疗的总有效率为96.8%(60/62).CMV相关疾病的治疗总有效率为89.5%(17/19),2例患者因CMV相关肺炎伴急性GVHD而死亡,CMV相关疾病的直接死亡率为1.9%(2/103).结论 在不进行预防性治疗的前提下,CMV血症和CMV相关疾病发生率未见升高.抢先治疗能有效阻止大部分CMV血症患者发病,并能有效控制CMV相关疾病的进展.     

抢先治疗异基因造血干细胞移植后巨细胞病毒感染的临床分析

目的 回顾性分析抢先治疗异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)感染的临床意义.方法 allo-HSCT治疗的患者103例,采用荧光定量PCR法监测CMV-DNA,并根据其结果抢先治疗CMV相关疾病,分析抢先治疗对于阻止CMV血症发展为CMV相关疾病的意义.结果 103例患者中检测出63例次(51例)CMV-DNA阳性,CMV血症发生率为49.5%,经抢先治疗19例发生CMV相关疾病,发生率为18.4%.60例次CMV血症经更昔洛韦和(或)膦甲酸治疗转阴,1例不可评价疗效,治疗的总有效率为96.8%(60/62).CMV相关疾病的治疗总有效率为89.5%(17/19),2例患者因CMV相关肺炎伴急性GVHD而死亡,CMV相关疾病的直接死亡率为1.9%(2/103).结论 在不进行预防性治疗的前提下,CMV血症和CMV相关疾病发生率未见升高.抢先治疗能有效阻止大部分CMV血症患者发病,并能有效控制CMV相关疾病的进展.     

抢先治疗异基因造血干细胞移植后巨细胞病毒感染的临床分析

目的 回顾性分析抢先治疗异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)感染的临床意义.方法 allo-HSCT治疗的患者103例,采用荧光定量PCR法监测CMV-DNA,并根据其结果抢先治疗CMV相关疾病,分析抢先治疗对于阻止CMV血症发展为CMV相关疾病的意义.结果 103例患者中检测出63例次(51例)CMV-DNA阳性,CMV血症发生率为49.5%,经抢先治疗19例发生CMV相关疾病,发生率为18.4%.60例次CMV血症经更昔洛韦和(或)膦甲酸治疗转阴,1例不可评价疗效,治疗的总有效率为96.8%(60/62).CMV相关疾病的治疗总有效率为89.5%(17/19),2例患者因CMV相关肺炎伴急性GVHD而死亡,CMV相关疾病的直接死亡率为1.9%(2/103).结论 在不进行预防性治疗的前提下,CMV血症和CMV相关疾病发生率未见升高.抢先治疗能有效阻止大部分CMV血症患者发病,并能有效控制CMV相关疾病的进展.     

抢先治疗异基因造血干细胞移植后巨细胞病毒感染的临床分析

目的 回顾性分析抢先治疗异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(CMV)感染的临床意义.方法 allo-HSCT治疗的患者103例,采用荧光定量PCR法监测CMV-DNA,并根据其结果抢先治疗CMV相关疾病,分析抢先治疗对于阻止CMV血症发展为CMV相关疾病的意义.结果 103例患者中检测出63例次(51例)CMV-DNA阳性,CMV血症发生率为49.5%,经抢先治疗19例发生CMV相关疾病,发生率为18.4%.60例次CMV血症经更昔洛韦和(或)膦甲酸治疗转阴,1例不可评价疗效,治疗的总有效率为96.8%(60/62).CMV相关疾病的治疗总有效率为89.5%(17/19),2例患者因CMV相关肺炎伴急性GVHD而死亡,CMV相关疾病的直接死亡率为1.9%(2/103).结论 在不进行预防性治疗的前提下,CMV血症和CMV相关疾病发生率未见升高.抢先治疗能有效阻止大部分CMV血症患者发病,并能有效控制CMV相关疾病的进展.