Cytomegalovirus infections after allogeneic bone marrow transplantation.
Cytomegalovirus infections after allogeneic bone marrow transplantation.
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同种异体骨髓移植后巨细胞病毒感染。
DOI：
10.1093/clinids/12.supplement_7.s776
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发表时间：
1990
期刊：
影响因子：
--
通讯作者：
Champlin,RE
中科院分区：
文献类型：
--
作者：
Winston,DJ;Ho,WG;Champlin,RE
巨细胞病毒 (CMV) 感染发生在所有同种异体骨髓移植受者中约 50%，并且在 CMV 血清阳性患者中比 CMV 血清阴性患者中更常见。感染源包括潜伏内源性病毒的再激活、CMV 血清阳性献血者的血液制品以及将 CMV 血清阳性供者的骨髓用于 CMV 血清阴性受者。同种异体移植受者中与 CMV 感染相关的最常见和最严重的临床综合征是间质性肺炎，约 50% 的患者会发生这种症状。 CMV 肺炎的危险因素包括年老、全身照射和严重的移植物抗宿主病。支气管肺泡灌洗液的免疫化学染色或用 CMV 单克隆抗体离心细胞培养物有助于 CMV 肺炎的快速诊断。 CMV 肺炎的治疗仍然存在问题，但静脉注射免疫球蛋白 (IVIG) 加更昔洛韦的联合治疗已使生存率大大高于先前抗病毒治疗试验所取得的生存率。在 CMV 血清阴性患者中，使用 CMV 血清阴性血液制品和 IVIG 可以预防或改善 CMV 感染和肺炎。 IVIG 还可能具有预防接受 CMV 血清阴性血液制品的患者的其他感染并发症和移植物抗宿主病的额外益处。对于 CMV 血清阳性患者，尚未建立对 CMV 再激活和肺炎的有效预防方法，但预防性更昔洛韦的临床试验正在进行中。
Cytomegalovirus (CMV) infection occurs in ∼50% of all recipients of allogeneic bone marrow transplants and is seen more frequently in CMV-seropositive patients than in CMV-seronegative patients. Sources of infection include reactivation of latent endogenous virus, blood products from CMV-seropositive blood donors, and the use of marrow from a CMV-seropositive donor for a CMV-seronegative recipient. The most common and severe clinical syndrome associated with CMV infection in allogeneic transplant recipients is interstitial pneumonia, which occurs in ∼50% of patients. Risk factors for CMV pneumonia include old age, conditioning with total-body irradiation, and severe graft-vs.-host disease. The rapid diagnosis of CMV pneumonia has been facilitated by immunochemical staining of bronchoalveolar lavage fluid or by centrifugation of cell cultures with CMV monoclonal antibodies. The treatment of CMV pneumonia remains problematic, but therapy with a combination of intravenous immune globulin (IVIG) plus ganciclovir has resulted in survival rates substantially better than those achieved in previous trials of antiviral therapy. In CMV-seronegative patients, CMV infection and pneumonia can be prevented or modified by the use of CMV-seronegative blood products and IVIG. IVIG may also have the additional benefits of preventing other infectious complications and graft-vs.-host disease in patients receiving CMV-seronegative blood products. For CMV-seropositive patients, effective prophylaxis for CMV reactivation and pneumonia has not yet been established, but a clinical trial of prophylactic ganciclovir is now under way.