单倍体骨髓移植后巨细胞病毒感染的防治

目的:研究单倍型骨髓移植后,巨细胞病毒(CMV)感染的预防策略及发病情况。方法:98例单倍型骨髓移植患者,62例及1例CMVpp65阳性供者,接受更昔若韦预防治疗,受者5 mg／kg,2次／d,移植前-9 d～-2 d,31例移植后出现CMV抗原血症阳性患者,其中18／60例预防组,13／35例非预防组阳性病例,接受更昔若韦5 mg／kg,2次／d×2周,后改为5 mg／kg,1次／d,到CMVpp65转阴。移植后CMVpp65每周检测1次。结果:预防组18／60例移植后出现CMV抗原血症阳性,出现中位时间56(25～84)d。非预防组13／35例CMVpp65阳性,中位时间52(19～75)d,前者1例患者(1．6％)发展为CMV结肠炎,后者4例(11．4％),2例CMV肺炎,1例CMV结肠炎,1例CMV脑炎。结论:单倍型骨髓移植后,用CMVpp65检测CMV抗原血症是一种简便,可靠的方法。低剂量短疗程,静脉注射更昔若韦提前预防CMV病可能是一种有效的方法。

Prevention and management of cytomegalovirus infection after haploidentical bone manow transplantation

Objective: To investigate the incidence of CMV infection and the method of prevention after hap-loidentical BMT. Method:In 98 patients receiving haploidentical BMT, 62 patients and one donor with pp65 positive received intravenous low-dose short-course ganciclovir 5 mg/kg twice daily before BMT-9 to-2 days as prophylaxis. 31 pp65 positive patients after-BMT (18/60 prophylaxis group and 13/35 non-prophylaxis) received ganciclovir. They were monitored weekly with CMV pp65 assay. If positive, these patients were given ganciclovir 5 mg/kg twice a day for 2 weeks, then 5 mg/kg once a day until pp65 become negative. Result: 18/60 patients (prophylaxis group) had CMV antigenemia at median of day 56(22-84)days and 13/35 patients (non prophylaxis group) CMV antigenemia occurred at a median of day 52(19-75) day. Among CMVpp65 positive patients received ganciclovir prophylaxis, one patient developed CMV disese (CMV colitis 1.6%). In non-prophylaxis group, four patients (11. 4%) developed CMV disease (two pneumonia. one colitis and one encephalitis). Conclusion: CMV pp65 assay is a simple and reliable method for CMV antigenemia surveillance. Low dose short-course intravenous ganciclovir as prophylaxis for CMV disease is an effective method for patients receiving haploideatical BMT.