Clinical analysis of the efficacies of ganciclovir plus foscarnet and a single antiviral drug for the treatment of cytomegalovirus infection after haploidentical stem cell transplantation
10.3760/cma.j.cn112138-20220118-00058
- VernacularTitle:联合方案和单药方案治疗单倍型造血干细胞移植后巨细胞病毒感染的临床分析
- Author:
Rui MA
1
;
Yun HE
;
Lanping XU
;
Xiaohui ZHANG
;
Yu WANG
;
Kaiyan LIU
;
Xiaojun HUANG
;
Yuqian SUN
Author Information
1. 北京大学人民医院血液科 北京大学血液病研究所 国家血液系统疾病临床医学研究中心 造血干细胞移植治疗血液病北京市重点实验室，北京 100044
- Keywords:
Hematopoietic stem cell transplantation;
Cytomegalovirus infections;
Drug therapy, combination
- From:
Chinese Journal of Internal Medicine
2023;62(1):76-83
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate and compare the efficacies of ganciclovir plus foscarnet and a single agent for the treatment of cytomegalovirus (CMV) infection after haploidentical hematopoietic stem cell transplantation.Methods:This study was a non-randomized clinical controlled trial. The data of patients who underwent haploidentical transplantation and developed CMV infection between January 1, 2021, and June 30, 2021, were retrospectively analyzed. Follow-up was conducted through telephone, inpatient consultations, and the review of outpatient medical records. The observed indicators included the incidence of CMV infection (including CMV disease), rate of recurrence of CMV infection, overall survival (OS), and disease-free survival (DFS).Results:A total of 242 patients were diagnosed with post-transplantation CMV infection; 116 patients tested positive for CMV DNA for more than 14 days ( P=0.011). Of the 242 patients with CMV infection, 65 were treated with ganciclovir plus foscarnet, and 156 patients were treated with a single antiviral drug; the median durations of CMV seroconversion were 21 (3-60) and 14 (3-32) days for the combination and single-drug groups, respectively. There were no significant differences between their incidence of CMV infections and 1-year OS and DFS. Of the patients with refractory CMV infections, 53 (45.7%) were treated with ganciclovir plus foscarnet, and 63 (54.3%) were treated with a single antiviral agent. The median durations of CMV seroconversion for the combination and single-drug groups were 21 (15-60) days and 20 (15-45) days, respectively ( P=0.472). Two patients in each group progressed to CMV disease ( P=0.860). During follow-up, 12 patients (22.6%) in the combination group and 8 patients (12.7%) in the single-drug group experienced recurrent episode(s) of CMV infection ( P=0.158). The 1-year OS of the combination and single-drug groups were 92.0% and 87.1%, respectively ( P=0.543); the 1-year DFS were 90.3% and 85.7%, respectively ( P=0.665). Univariate analysis revealed no associations between the antiviral agents used and OS and DFS (OS: HR=0.644, P=0.547; DFS: HR=0.757, P=0.666). Conclusions:There were no significant differences in the duration of CMV infection, incidence of CMV disease, rate of recurrence of CMV infection, and survival of the patients treated with the combination of antiviral drugs and a single antiviral drug.
