Ganciclovir three times per week is not adequate to prevent cytomegalovirus reactivation after T cell-depleted marrow transplantation.
To determine if ganciclovir given three times per week post-transplant is tolerable and effective for prevention of cytomegalovirus (CMV) infection in recipients of T cell-depleted marrow from related or unrelated donors, we have used ganciclovir 2.5 mg/kg iv three times daily on days -8 to -2 and 5 or 6 mg/kg iv 3 times per week from engraftment to day 100 as CMV prophylaxis for 51 adults who were CMV-seropositive or had seropositive donors. All patients received iv immunoglobulin 500 mg/kg weekly and CMV-negative or filtered blood products. Blood and urine were tested for CMV at weekly intervals through day 100. All patients received ganciclovir pre-transplant. Ten patients did not receive ganciclovir post-transplant (5 deaths, 3 graft failure, 1 renal failure, 1 required foscarnet). The median time to initiation of ganciclovir was 27 days (range 17-59 days) and the median duration of therapy was 51 days (range 5-83 range). Twelve patients had dose reductions (3 neutropenia and 9 renal insufficiency). Seven patients died before day 100, 2 had indications to change to foscarnet, 15 discontinued ganciclovir because of neutropenia and 17 completed the full ganciclovir course through day 100. G- or GM-CSF was given to 29 patients with neutrophils < 1.5 x 10(9)/l (10 had neutrophils < 0.5 x 10(9)/l) but only 12 of them could continue full-dose ganciclovir. Bacteremia occurred in 12 of the neutropenic patients. At day 120, the actuarial rate of CMV infection was 58% (95% CI 42-74%) and that of CMV disease was 36% (95% CI 21-51%).(ABSTRACT TRUNCATED AT 250 WORDS)
Przepiorka
D
D
University of Texas M.D. Anderson Cancer Center, Department of Hematology, Houston.
Ippoliti
C
C
Panina
A
A
Goodrich
J
J
Giralt
S
S
van Besien
K
K
Mehra
R
R
Deisseroth
A B
AB
Andersson
B
B
Luna
M
M
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D003587:Cytomegalovirus / Q000187:drug effects* / Q000254:growth & development; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D004334:Drug Administration Schedule; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use; D015774:Ganciclovir / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D016867:Immunocompromised Host; D015993:Life Tables; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000209:etiology; D011292:Premedication; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013601:T-Lymphocytes; D017211:Treatment Failure; D014775:Virus Activation / Q000187:drug effects*
D017245:Foscarnet; D015774:Ganciclovir