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抢先抗巨细胞病毒治疗策略在不同类型造血干细胞移植中的疗效比较

ISSN号：0578-1426
期刊名称：中华内科杂志
时间：0
页码：476-480
语言：中文
分类：R457.7[医药卫生—治疗学;医药卫生—临床医学] R512.62[医药卫生—临床医学;医药卫生—内科学]
作者机构：[1]北京大学人民医院北京大学血液病研究所,100044
相关基金：国家“863”基金项目（2006AA02Z4A0）;国家杰出青年基金项目（30725038）;教育部创新团队支持计划（IRT0702）
相关项目：HSP-HA-1H重组核酸疫苗的构建及其诱导HSCT后GVL效应的研究

作者：许兰平|韩伟|刘开彦|张晓辉|赵晓甦|刘代红|陈欢|黄晓军|陈育红|HUANG Xiao-jun|王昱|

关键词：血液病, 造血干细胞移植, 巨细胞病毒, 抢先治疗, Hematologic diseases, Hematopoietic stem cell transplantation, Cytomegalovirus, Preemptive therapy

中文摘要：

目的对不同类型异基因造血干细胞移植（HSCT）的巨细胞病毒（CMV）感染患者采用统一的抢先治疗指征，比较抗病毒治疗的效果，从而评价抢先治疗策略的临床应用价值。方法进行异基因HSCT患者318例，自移植后采用实时定量（RQ）-PCR法监测血浆CMV—DNA水平，其中136例出现CMV感染，全相合HSCT31例，亲缘半相合HSCT88例，非血缘HSCT17例。三种类型移植采用相同的抗病毒抢先治疗指征，比较CMV—DNA拷贝数的转阴率、CMV病的发生率及患者的长期生存率。结果136例CMV感染患者分别采用更昔洛韦、膦甲酸钠或缬更昔洛韦进行抗病毒抢先治疗，全相合、半相合及非血缘移植组治疗的中位时间相近，三组患者CMV—DNA最终转阴率相似（96．8％，93．2％，88．2％），组间比较差异均无统计学意义（P〉0．05）。抢先治疗后三组患者发生CMV肺炎及肠炎的比例及死于CMV病几率的差异也无统计学意义（P〉0．05）。各类型移植患者的长期生存率差异无统计学意义（P=0．88），发生Ⅱ～Ⅳ度急性移植物抗宿主病（aGVHD）患者生存率明显低于0～Ⅰ度aGVHD患者（P=0．036）。结论不同类型造血干细胞移植术后的CMV感染患者，采用基于RQ-PCR监测的抢先治疗策略可达到相同的疗效。

英文摘要：

Objective Coherent preemptive therapy criterion was applied in various kinds of allogenic hematopoietic stem-cell transplant （allo-HSCT） recipients with cytomegalovirus （CMV） infection in order to evaluate its clinical value in various kinds of HSCT. Methods A total of 318 allo-HSCT patients were monitored for CMV infection. Real-time quantitative polymerase chain reaction （RQ-PCR） was performed to serially monitor CMV viremia after transplantation. There were 136 patients infected with CMV including 31 of HLA-matched sibling, 88 of HLA-mismatched related and 17 of unrelated donor HSCT. Coherent preemptive therapy criterion was employed. The clearance rate of DNAemia, incidence of CMV disease and overall survival rate were compared among the three types of HSCT. Results All the 136 patients with CMV DNAemia were treated with ganciclovir, foscamet and valganciclovir, respectively. The period of treatment and the clearance rate of DNAemia were comparable among the HLA-matched, HLA- mismatched related and unrelated donor HSCT groups （ 96. 8% , 93.2% and 88. 2% ）（ P 〉 0. 05 ）. The incidence of CMV pneumonia and CMV enteritis and overall survival rate among the three groups were similar and there was no significant difference in the proportion of patients dying of CMV diseases （ P 〉 0.05 ）. However, the overall survival rate of the patients with Ⅱ-Ⅳ acute graft-versus-host disease （aGVHD） was much lower than that of the patients with 0- Ⅰ aGVHD. Conclusion Similar curative effect can be observed when preemptive therapy is applied in various kinds of allo-HSCT recipients with eytomegalovirus infection based on the results of RQ-PCR.