Effect of high-dose acyclovir on survival in allogeneic marrow transplant recipients who received ganciclovir at engraftment or for cytomegalovirus pp65 antigenemia.
This study sought to determine whether high-dose acyclovir improves posttransplant survival in cytomegalovirus (CMV)-seropositive patients when ganciclovir is given for prophylaxis or as early therapy. Three groups were studied: Group 1 (n = 112) received ganciclovir from engraftment without prior acyclovir treatment, group 2 (n = 114) was given ganciclovir for CMV pp65 antigenemia without prior acyclovir, and group 3 (n = 133) received ganciclovir at engraftment with prior intravenous acyclovir (500 mg/m2 every 8 h) from day 5 before transplant until engraftment. In a multivariable Cox model, there was no significant difference in the adjusted risk of transplant survival between the groups during the first 2 years after transplant (relative risk for mortality: group 1, 1.0; group 2, 0.75 (95% confidence interval [CI], 0.52-1.1); group 3, 1.04 (95% CI, 0.74-1.47). The incidence of CMV disease and CMV-related mortality was not significantly different between the groups. Thus, high-dose acyclovir does not appear to improve survival when ganciclovir is given either at engraftment or for CMV pp65 antigenemia.
Boeckh
M
M
Fred Hutchinson Cancer Research Center, Seattle, Program in Infectious Diseases, 98109-4417, USA. mboeckh@fhcrc.org
Gooley
T A
TA
Bowden
R A
RA
D000212:Acyclovir / Q000008:administration & dosage / Q000627:therapeutic use*; D000956:Antigens, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000401:mortality*; D018890:Chemoprevention; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D010750:Phosphoproteins / Q000097:blood; D016016:Proportional Hazards Models; D016019:Survival Analysis; D014184:Transplantation, Homologous
D000956:Antigens, Viral; D000998:Antiviral Agents; D010750:Phosphoproteins; D015774:Ganciclovir; D000212:Acyclovir