马立巴韦治疗异基因造血干细胞移植后难治与药物不耐受CMV血症和CMV病25例临床分析  

Maribavir treatment for refractory and drug-intolerant cytomegalovirus viremia and disease after allogeneic hematopoietic stem cell transplantation:a clinical analysis of 25 cases

作　　者：马薇 魏志杰 卢岳 张建平 孙瑞娟 熊敏 周葭蕤 董磊 薛松 曹星玉 Ma Wei;Wei Zhijie;Lu Yue;Zhang Jianping;Sun Ruijuan;Xiong Min;Zhou Jiarui;Dong Lei;Xue Song;Cao Xingyu(Department of Bone Marrow Transplantation,Hebei Yanda Lu Daopei Hospital,Langfang 065201,China;Department of Bone Marrow Transplantation,Beijing Lu Daopei Hospital,Beijing 101102,China)

机构地区：[1]河北燕达陆道培医院造血干细胞移植科,廊坊065201 [2]北京陆道培医院移植科,北京100176

出　　处：《中华血液学杂志》2024年第11期1010-1015,共6页Chinese Journal of Hematology

摘　　要：目的探讨马立巴韦治疗异基因造血干细胞移植(allo-HSCT)后难治性、对常规抗病毒药物不耐受的巨细胞病毒(cytomegalovirus,CMV)血症和CMV病的安全性和有效性。方法回顾性分析2024年4月至2024年9月在河北燕达陆道培医院马立巴韦治疗allo-HSCT后的难治性、对常规抗病毒药物不耐受的CMV血症和CMV病的结局。结果接受马立巴韦治疗的25例患者,其中亲缘单倍型移植21例,同胞全合移植2例,非血缘移植2例。1次移植21例,2次移植2例和3次移植2例。患者发生CMV血症的中位时间为移植后120.5(6~298)d,血浆CMV最高拷贝中位数为6400(1100~650000)拷贝/ml。6例患者诊断CMV病。患者在CMV感染后的9.5(1~41)d开始使用马立巴韦。使用马立巴韦持续中位时间为11.5(6~43)d。25例患者治疗均有效。2例患者发生1级的味觉异常,1例发生2级骨髓抑制。结论allo-HSCT后难治性、药物不耐受的CMV血症和CMV病患者应用马立巴韦治疗安全有效。Objective To investigate the safety and efficacy of maribavir for the treatment of CMV viremia and CMV disease refractory or intolerant to conventional antiviral drugs after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods This study retrospectively analyzed the clinical characteristics and outcomes of CMV viremia and CMV disease refractory or intolerant to conventional antiviral drugs after allo-HSCT treated with maribavir at Hebei Yanda Lu Daopei Hospital from April 2024 to September 2024.Result A total of 25 patients received maribavir,including 21 haploidentical transplants,two sibling HLA-matched transplants,and 2 HLA-matched unrelated transplants.Among them,21,2,and 2 patients received the first,second,and third transplants,respectively.The median time to the onset of CMV viremia and CMV disease was 120.5(6-298)days posttransplantation.The median peak plasma CMV copy number was 6400 copies/ml(range:1100-650000 copies/ml).Six patients were diagnosed with CMV disease.Maribavir was administered after a median of 9.5(1-41)days after CMV infection.The median duration of maribavir administration was 11.5(6-43)days.Post-treatment,maribavir was effective in 25(100%)patients.Two patients experienced grade 1 taste abnormalities,and one patient experienced grade 2 myelosuppression.Conclusion The application of maribavir after allo-HSCT for treating refractory,drug-intolerant CMV viremia and CMV disease is safe and effective.

关 键 词：巨细胞病毒 异基因造血干细胞移植 马立巴韦 

分 类 号：R457.7[医药卫生—治疗学]