Granulocyte recovery in pediatric marrow transplant recipients treated with ganciclovir for cytomegalovirus infection.
OBJECTIVE
Cytomegalovirus (CMV) infection remains a major cause of morbidity and mortality after bone marrow transplantation (BMT). Ganciclovir is a guanosine analogue that selectively inhibits CMV DNA polymerase and appears to be a useful agent for BMT patients with CMV pneumonia. One major side effect of ganciclovir is neutropenia, and there may be reluctance to administer ganciclovir to neutropenic patients. However, there is evidence that CMV infection may directly or indirectly cause marrow suppression. In this situation, the potential benefit of ganciclovir may outweigh the risk.


METHODS
We retrospectively reviewed the charts of 11 consecutive patients receiving ganciclovir for CMV infection posttransplant. A total of 13 courses of ganciclovir were administered.


RESULTS
In 10 of 13 cases, the absolute neutrophil count was higher at the completion of ganciclovir therapy than at the start of treatment, including five cases where the absolute neutrophil count was < 500/mm3 at the time ganciclovir was started. In only one of 13 cases was ganciclovir discontinued due to neutropenia.


CONCLUSIONS
We conclude that the administration of ganciclovir is not often associated with the development of severe neutropenia in pediatric marrow transplant recipients and that ganciclovir can be safely administered to patients with CMV disease, who are severely neutropenic.
Division of Hematology/Oncology, Childrens Hospital Los Angeles, University of Southern California.
W D
WD
Roberts
K I
KI
Weinberg
D B
DB
Kohn
L
L
Sender
R
R
Parkman
C
C
Lenarsky
D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000188:drug therapy*; D005260:Female; D015774:Ganciclovir / Q000009:adverse effects* / Q000627:therapeutic use; D006098:Granulocytes / Q000187:drug effects*; D006801:Humans; D007223:Infant; D008297:Male; D009503:Neutropenia / Q000139:chemically induced; D012189:Retrospective Studies
D015774:Ganciclovir