Cytomegalovirus pneumonia after bone marrow transplantation. Risk factors and response to therapy.
Cytomegalovirus pneumonia after bone marrow transplantation. Risk factors and response to therapy.
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骨髓移植后巨细胞病毒肺炎。
DOI：
10.1097/00007890-199306000-00024
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发表时间：
1993
期刊：
影响因子：
6.2
通讯作者：
Miller,W
中科院分区：
文献类型：
--
作者：
Enright,H;Haake,R;Weisdorf,D;Ramsay,N;McGlave,P;Kersey,J;Thomas,W;McKenzie,D;Miller,W
1136例骨髓移植受者中巨细胞病毒肺炎并发75例（异体63例，自体12例）（Kaplan-Meier发生率8.8%）。同种异体受体（12.4%）比自体受体（3.3%）更容易发生巨细胞病毒肺炎。在血清阳性（相对危险度= 2.9）、年龄较大（相对危险度= 1.4 / 10年）、接受全身照射（相对危险度= 2.7）、接受抗胸腺细胞球蛋白（相对危险度= 2.9）或T细胞枯竭骨髓（相对危险度= 2.7）或有巨细胞病毒血症（相对危险度= 4.0）或病毒血症（相对危险度= 5.9）的同种异体受体中观察到巨细胞病毒肺炎的风险增加。自体受体血清学阳性（RR= 6.1）或出现病毒血症（RR= 7.0）或病毒血症（RR= 15.4）的风险也增加。14例未经治疗的患者中有13例无好转而死亡。治疗开始时依赖呼吸机的患者预后较差（中位生存期为17天），仅有1例长期存活。相比之下，在开始使用更昔洛韦和免疫球蛋白治疗时不依赖呼吸机的患者（n= 22）的中位生存期为50274天，其中9人长期存活。更昔洛韦单用或阿昔洛韦联合免疫球蛋白治疗不依赖呼吸机的患者效果较差（中位生存期分别为80天和10天）。总体而言，75例患者中有10例自诊断后存活10 - 73个月（中位47个月）；其中9例在治疗开始时不依赖呼吸机，接受更昔洛韦和免疫球蛋白治疗。巨细胞病毒肺炎不太常见，但在自体受体中很严重，12例中只有2例存活。巨细胞病毒肺炎仍然是BMT后死亡的主要原因。呼吸衰竭发生前早期应用更昔洛韦和免疫球蛋白治疗可提高生存率。
Cytomegalovirus pneumonia complicated bone marrow transplantation in 75 (63 allogeneic and 12 autologous) of 1136 recipients (Kaplan-Meier incidence 8.8%). CMV pneumonia occurred more frequently in allogeneic (12.4%) than autologous recipients (3.3%). Increased risk for CMV pneumonia was observed in allogeneic recipients who were seropositive (relative risk= 2.9), older age (RR= 1.4 per decade), those conditioned with total—body irradiation (RR= 2.7), who received antithymocyte globulin (RR= 2.9) or T cell-depleted marrow (RR= 2.7) or who had CMV viruria (RR= 4.0) or viremia (RR= 5.9). Autologous recipients were also at increased risk if they were seropositive (RR= 6.1), or developed viruria (RR= 7.0) or viremia (RR= 15.4). Thirteen of 14 untreated patients died without improvement. Prognosis was poor in patients who were ventilator-dependent at initiation of therapy (median survival 17 days), with only 1 long-term survivor. In contrast, patients ventilator-independent at initiation of therapy with ganciclovir and immunoglobulin (n= 22) had a median survival of> 274 days, with 9 long-term survivors. Ganciclovir alone or acyclovir with immunoglobulin in ventilator-independent patients was less effective (median survivals 80 and 10 days, respectively). Overall, 10 of 75 patients were surviving 10–73 months (median 47) from diagnosis; 9 of these were ventilator-independent at initiation of therapy and received ganciclovir with immunoglobulin. CMV pneumonia was less common, but was severe in autologous recipients, with only 2 of 12 surviving. CMV pneumonia remains a prominent cause of death following BMT. Early therapy with ganciclovir and immunoglobulin before respiratory failure supervenes may improve survival.