Foscarnet for prevention of cytomegalovirus infection in allogeneic marrow transplant recipients unable to receive ganciclovir
Foscarnet for prevention of cytomegalovirus infection in allogeneic marrow transplant recipients unable to receive ganciclovir
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膦甲酸用于预防无法接受更昔洛韦的同种异体骨髓移植受者的巨细胞病毒感染
DOI：
10.1038/sj.bmt.1700910
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发表时间：
1997
影响因子：
4.8
通讯作者：
D. Przepiorka
中科院分区：
文献类型：
--
作者：
C. Ippoliti;A. Morgan;D. Warkentin;K. V. Besien;R. Mehra;I. Khouri;S. Giralt;J. Gajewski;R. Champlin;B. Andersson;D. Przepiorka
移植后预防性应用更昔洛韦可预防巨细胞病毒(CMV)病。然而，多达30%的患者由于严重的中性粒细胞减少而停止使用更昔洛韦，并可能随后在没有保护措施的情况下发展为CMV感染。为了防止CMV的再次激活，我们对39名因植入延迟或更昔洛韦引起的中性粒细胞减少而无法接受更昔洛韦治疗的成年人使用了磷卡奈特。24名患者(62%)接受了T细胞耗尽的骨髓移植。磷甲酸钠60 mg/kg静脉滴注，每日1次，直至中性粒细胞减少症状消失，此时恢复使用更昔洛韦。CMV预防在移植后28天的中位数开始。开始应用磷甲酸钠的中位时间是移植后60天，治疗的中位持续时间是22天。对福斯卡奈特的耐受性很好。6名患者(15%)在接受预防治疗时检测到巨细胞病毒，巨细胞病毒相关死亡率为5%。在无法接受更昔洛韦治疗的异基因移植受者中，磷甲酸钠是一种安全有效的预防巨细胞病毒病的药物。
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 iv 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.