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[目的]分析急性白血病异基因造血干细胞移植(Allo-HCT)中接受两种不同预处理方案的患者巨细胞病毒(CMV)感染和发病情况,评价预处理方案。[方法]对2004年3月～2011年3月在四川大学华西医院接受Allo-HCT的57例急性白血病患者进行回顾性分析,据预处理方案不同分为A组和B组,A组为白消安、环磷酰胺、阿糖胞苷方案(BuACy方案),有22例;B组为白消安、氟达拉滨、阿糖胞苷方案(BFA方案),有35例。根据临床表现将CMV病毒感染分为CMV血症和CMV病。CMV血症定义为有CMV病原学证据(CMV-DNA检测阳性和/或CMV-IgG,IgM均阳性)但无CMV感染症状;CMV病定义为有CMV病原学证据及病毒临床损害表现。[结果]移植后共发生22例CMV感染(14例CMV血症,8例CMV病),其中A组感染10例(45.5%),包括CMV病7例(31.8%);B组感染12例(34.3%),包括CMV病1例(2.86%)。通过卡方检验,两组患者CMV感染率差异无统计学意义(χ2=0.318,P﹥0.05);但CMV病发生率差异有统计学意义(χ2=7.14,P﹤0.05)。[结论]在异基因外周血造血干细胞移植术中通过采用BFA方案预处理能减少CMV病发生率,改善患者预后。
[Objective] To analyze the infection and incidence of cytomegalovirus (CMV) in patients receiving two different pretreatment regimens in allo-HCT of acute leukemia and to evaluate the pretreatment regimen. [Methods] A total of 57 acute leukemia patients who received Allo-HCT from West China Hospital of Sichuan University from March 2004 to March 2011 were retrospectively analyzed. According to the different pretreatment protocols, they were divided into A group and B group. A group was white There are 22 cases of carbamazepine, cyclophosphamide and cytarabine (BuACy regimen), while there are 35 cases of bupivacaine, fludarabine and cytarabine in group B (BFA regimen). According to the clinical manifestations of CMV virus infection is divided into CMV disease and CMV disease. CMV hyperlipidemia is defined as having etiological evidence of CMV (CMV-DNA positive and / or CMV-IgG positive for IgM) but no symptoms of CMV infection; CMV disease is defined as evidence of CMV etiology and clinical manifestations of the virus. [Results] A total of 22 cases of CMV infection (14 cases of CMV exacerbation and 8 cases of CMV disease) occurred after transplantation. Among them, 10 cases (45.5%) were infected in group A, including 7 cases (31.8%) with CMV disease and 12 cases (34.3%), including 1 case of CMV disease (2.86%). By chi-square test, there was no significant difference in CMV infection rates between the two groups (χ2 = 0.318, P> 0.05). However, the incidence of CMV was significantly different (χ2 = 7.14, P <0.05). [Conclusion] Pretreatment with BFA in allogeneic peripheral blood stem cell transplantation can reduce the incidence of CMV and improve the prognosis of patients.