Pre-emptive therapy against cytomegalovirus (CMV) disease guided by CMV antigenemia assay after allogeneic hematopoietic stem cell transplantation: a single-center experience in Japan
Pre-emptive therapy against cytomegalovirus (CMV) disease guided by CMV antigenemia assay after allogeneic hematopoietic stem cell transplantation: a single-center experience in Japan
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DOI：
10.1038/sj.bmt.1702805
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发表时间：
2001-02-01
影响因子：
4.8
通讯作者：
Takaue, Y
中科院分区：
文献类型：
--
作者：
Kanda, Y;Mineishi, S;Takaue, Y
从1998年4月到2000年3月，在国家癌症中心医院对77例接受同种异体造血干细胞移植的成年巨细胞病毒（CMV）抗原引导的巨细胞病毒（CMV）疾病的预防性治疗方法进行了评估。植入后至少每周进行一次巨细胞病毒抗原血症检测。高水平抗原血症被定义为每5万个细胞中有10个或更多的阳性细胞，低水平抗原血症被定义为少于10个阳性细胞。在74例首次移植患者中，51例出现了抗原阳性血症，替代供体移植和II-IV级GVHD的发展是抗原阳性血症的独立危险因素，39例患者以风险适应方式给予更昔洛韦作为先发制人的治疗。9例初始阳性结果为低水平抗原血症的低风险患者中，即使未使用更昔洛韦，也没有出现高水平抗原血症。在研究期间，只有1例患者出现早期巨细胞病毒疾病（肝炎），CMV抗原血症在除2例患者外的所有患者中都得到了解决，其中2例患者用foscarnet代替了更昔洛韦。然而，在8例患者中，中性粒细胞计数在开始更昔洛韦后下降到0.5 × 10(9)/l或更低，其中3例有记录的感染，2例随后继发性移植物失败。更昔洛韦的总剂量以及大剂量更昔洛韦的持续时间可能影响中性粒细胞减少症的发生率。我们得出结论，抗原引导下的先发制人治疗，减少更昔洛韦的剂量和以反应为导向的剂量调整可能适合降低更昔洛韦的毒性，而不会增加CMV疾病的风险。
From April 1998 to March 2000, a cytomegalovirus (CMV) antigenemia-guided pre-emptive approach for CMV disease was evaluated in 77 adult patients who received allogeneic hematopoietic stem cell transplantation at the National Cancer Center Hospital. A CMV antigenemia assay was performed at least once a week after engraftment. High-level antigenemia was defined as a positive result with 10 or more positive cells per 50 000 cells and low-level antigenemia was defined as less than 10 positive cells. Among the 74 patients with initial engraftment, 51 developed positive antigenemia, Transplantation from alternative donors and the development of grade II-IV GVHD were independent risk factors for positive antigenemia, Ganciclovir was administered as pre-emptive therapy in 39 patients in a risk-adapted manner. None of the nine low-risk patients with few-level antigenemia as their initial positive result developed high-level antigenemia even though ganciclovir was withheld. Only one patient developed early CMV disease (hepatitis) during the study period, CMV antigenemia resolved in all but two cases, in whom ganciclovir was replaced with foscarnet, In eight patients, however, the neutrophil count decreased to 0.5 x 10(9)/l or less after starting ganciclovir, including three with documented infections and two with subsequent secondary graft failure. The total amount of ganciclovir and possibly the duration of high-dose ganciclovir might affect the incidence of neutropenia. We concluded that antigenemia-guided pre-emptive therapy with a decreased dose of ganciclovir and response-oriented dose adjustment might be appropriate to decrease the toxicity of ganciclovir without increasing the risk of CMV disease.