Clinical study on foscarnet prophylaxis and pre-emptive therapy for cytomegalovirus infection in hematopoietic stem cell transplantation
10.3760/cma.j.issn.1009-9921.2017.06.003
- VernacularTitle:膦甲酸钠预防及抢先治疗造血干细胞移植中巨细胞病毒感染的临床研究
- Author:
Yamei WU
;
Yongbin CAO
;
Xiaohong LI
;
Lixin XU
;
Bei YAN
;
Songwei LI
;
Haitao WANG
;
Yahui GAO
;
Tiantian ZHANG
;
Yaqian ZHANG
;
Li WANG
;
Xiaoxiong WU
- Keywords:
Cytomegalovirus;
Hematopoietic stem cell transplantation;
Foscarnet;
Pre-emptive therapy
- From:
Journal of Leukemia & Lymphoma
2017;26(6):331-335
- CountryChina
- Language:Chinese
-
Abstract:
Objective To observe the clinical safety and efficacy of foscarnet prophylaxis and pre-emptive therapy for cytomegalovirus (CMV) infection in allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods Ninety-six patients undergoing allo-HSCT from October 2014 to December 2016 were retrospectively analyzed. Plasma CMV-DNA was monitored with real-time quantitative polymerase chain reaction (RQ-PCR) from beginning to 180 days after transplantation. Foscarnet was used not only for prophylaxis but also for first-line pre-emptive therapy when plasma CMV-DNA turned to positive. Foscarnet was given 60 mg·kg-1·d-1 and 120 mg·kg-1·d-1 respectively in prevention and pre-emptive therapy. Incidences of CMV infection and CMV disease were observed, influencing factors on CMV in faction and the efficacy and safety of foscarnet prophylaxis were analyzed, and survival of patients treated by all-HSCT was evaluated. Results Of the total 96 patients, 42 cases (43.8%) had CMV infection with the median time of 42 days after allo-HSCT. CMV-DNA became negative in 36 patients (85.7%, 36/42) after pre-emptive therapy. Six patients (14.3 %, 6/42) developed CMV disease, including 5 patients with CMV negative and 1 patient died for CMV pneumonia. Haploidentical donor and grade Ⅱ-Ⅳacute graft versus host disease (GVHD) were the risk factors for CMV reactivation (χ2 = 3.834, P< 0.05; χ2 = 16.807, P< 0.001). The side effects of foscarnet prophylaxis were mild without hematologic toxicities. 12 patients (28.6 %) died in 42 patients with CMV infection, and 6 patients (11.1 %) died in 54 patients without CMV infection. The difference of survival rates between both groups was not statistically significant. Conclusion Foscarnet is an effective agent for prophylaxis and pre-emptive therapy in CMV infection after allo-HSCT with mild adverse reactions, especially for patients following with hematopoietic recovering.
