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題名 | Cytomegalovirus Infection in Non-transplant Patients with Hematologic Neoplasms: A Case Series=非移植血液惡性病患的巨細胞病毒感染 |
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作者 | 張鴻; 湯崇志; 洪玉馨; 林棟樑; 郭明宗; 王博南; | 書刊名 | 長庚醫誌 |
卷期 | 34:1 2011.01-02[民100.01-02] |
頁次 | 頁65-74 |
分類號 | 415.6 |
關鍵詞 | 巨細胞病毒; 淋巴瘤; 多發性骨髓瘤; 白血病; 莫須瘤; Cytomegalovirus; Lymphoma; Multiple myeloma; Leukemia; Rituximab; |
語文 | 英文(English) |
中文摘要 | (Cytomegalovirus, CMV) 6 17 20 (rituximab) ganciclovir cytotect () 5 |
英文摘要 | Background: Cytomegalovirus (CMV) infection is uncommon in hematology patients. The clinical pictures and outcomes of this virus are not entirely clear. Method: Consecutive cases of CMV infection (17 patients with 20 episodes) were compiled for study over a six year period. Results: CMV infection occurred in patients of various ages and with a number of underlying hematological diseases, including non-Hodgkin’s lymphoma, multiple myeloma (MM), acute myeloid leukemia (AML) and myeloproliferative neoplasm, No single laboratory assay was sensitive enough to serve as a screening test in the diagnosis of CMV infection. A combination of laboratory assays, clinical features and radiographic findings were required for diagnosis. All patients with AML or MM had received various chemotherapies before CMV infection. All but one lymphoma patient had received steroids and rituximab treatment prior to CMV infection. CMV infection episodes were accompanied by various co-infections in 60% (12/20) of cases. Bacterial lobar pneumonia was the most common form of co-infection. We used ganciclovir as the sole antiviral treatment in most of the infection episodes (18/20). Anti-CMV immunoglobulin (cytotect) was also provided to one patient because of persistent fever and dyspnea. Treatment was successful in all but one of the cases, which occurred when ganciclovir was initiated after respiratory failure. This patient died of CMV pneumonia. The other patients had good initial responses to antiviral treatment, but their longterm outcome was poor. Only five patients survived after a short follow-up duration. Conclusions: In an era of intensive immuno-chemotherapy, CMV infection may become a serious threat for hematology patients. Physicians dealing with hematological malignancies should be aware of CMV infection, especially for patients receiving rituximab and steroids. |
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