Prevention of cytomegalovirus disease.
Cytomegalovirus (CMV) disease is a significant cause of morbidity in allogeneic bone-marrow and solid-organ transplant recipients. Because of this, a number of strategies to prevent this disease have been attempted, many of which were investigated before the approval of agents that are effective in treatment. However, in bone-marrow transplantation, treatment of established disease, particularly CMV pneumonitis, carries a high mortality rate despite appropriate management. A patient-survival benefit has been shown for preemptive therapy with ganciclovir initiated on the basis of a positive CMV surveillance culture from any site before post-transplant day 100, and this should be considered the current standard of care. Among solid-organ transplant recipients, no clear standard of care has emerged, and for most patients, the basic question of whether prophylaxis is more beneficial than treatment of symptomatic infection goes unanswered.
Bailey
T C
TC
Department of Internal Medicine, Washington University School of Medicine, St Louis, MO.
D000212:Acyclovir / Q000627:therapeutic use; D002985:Clinical Protocols; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D007116:Immunization, Passive / Q000379:methods; D016377:Organ Transplantation / Q000009:adverse effects*; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014611:Vaccination / Q000379:methods
D015774:Ganciclovir; D000212:Acyclovir