缬更昔洛韦治疗异基因造血干细胞移植受者巨细胞病毒血症的疗效和安全性

目的 分析缬更昔洛韦治疗造血干细胞移植(HSCT)后患者巨细胞病毒(CMV)血症的疗效和安全性.方法 选择2007年l至7月行HSCT的19例移植后CMV血症患者进行前瞻性研究.移植后应用定量多聚酶链反应(PCR)定期进行病毒DNA监测,CMV-DNA阳性,定量>6.0×102拷贝/ml的患者应用缬更昔洛韦900 mg 2次/d诱导治疗14 d,然后900 mg 1次/d维持治疗14 d.结果 HSCT后发生CMV血症的中位时间为移植后第40(20-83)天,诊断时CMV-DNA中位数3.346×103(9×102～4.2×103)拷贝/ml.缬更昔洛韦治疗的总有效率为94.7%,14 d转阴率84.2%.治疗前后CMV-DNA每日降低中位数0.084(0.045-0.25)10g 10拷贝·ml-1·d-1.常见不良反应为贫血、血小板下降和白细胞减少,且多为轻度;随访6个月无1例发展至CMV病.结论 缬更昔洛韦用于治疗HSCT后患者CMV血症安全有效.

Valganciclovir for treatment of cytomegalovirus viremia in patients following allogeneic hematopoietic stem cell transplantation

Objective To investigate the efficacy and safety of valganciclovir in treatment of cytomegalovirus viremia in patients following allogeneic hematopoietic stem cell transplantation(allo HSCT).Methods Nineteen patients following allo-HSCT were diagnosed as with cytomegalovims viremia with the CMV-DNA load of hisher than 6.0×102 copies/ml confirmed by polymerase chain reaction(PCR) took orally valganciclovir at the dose of 900 mg bid for 14 days followed bv 900 mg Qd for another 14 days. Since 4 weeks after the valganciclovir treatment PCR was conducted in the 6th,8th,12th,16th,and 24th weeks later to detect the CMV-DNA level.Results CMV viremia was confirmed 40 days after HSCT on average with a median CMV-DNA load of 3.346×103 copies/ml.The total effective rate of valganciclovir was 94.7%(18/19).The CMV-DNA turned to negative in 7 d in 11 eases with a negative transfer rate of 54.7%.and in 14 d in 16 cases with a negative transfer rate of 84.2%.The mediall CMV DNA load reduction was 0.75 eopies/ml and 0.084 log10 copies/ml/day.Severe adverse effects were not observed and CMV-related disease did not occur.Conclusion Valganeielovir is an attractive and safe alternative for preemptive CMV viremia treatment in allo-HSCT recipients.