title: Cytomegalovirus pp65 antigenemia-guided pre-emptive treatment with ganciclovir after allogeneic stem transplantation: a single-center experience.
abstract: The optimal prophylactic strategy for cytomegalovirus (CMV) disease after allogeneic hematopoietic stem cell transplantation has not yet been established. The aim of this study was to analyze our single-center experience with a uniform protocol of CMV antigenemia-guided pre-emptive treatment with ganciclovir (GCV) after allografting. Fifty-two consecutive adult patients, 48 of them transplanted from HLA-identical matched related donors were included. T cell-depleted marrow or peripheral blood were used in 21 cases. After engraftment, weekly blood samples were tested for CMV pp65 antigenemia and viremia (conventional cultures) until day +100. GCV was started if CMV antigenemia and/or CMV viremia were detected. CMV infection (CMV-I) was found in 19 patients (37%). Seven patients suffered from CMV disease (CMV-D), three colitis and four pneumonias. There was one death directly related to CMV-D and three further cases died from refractory GVHD with CMV-D. Only one patient developed CMV pneumonia without any previous positive antigenemia and/or viremia. Multivariate analysis identified grades II-IV acute GVHD (P = 0.02) and peripheral blood stem cell transplantation (P = 0.03) to be risk factors for developing CMV-I. In conclusion, this monitoring protocol allowed early treatment of CMV-I without progression to CMV-D. Pre-emptive therapy had the additional advantage of avoiding GCV administration in most of our allograft recipients.
authors.affiliation: Clinical Hematology Division, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Manteiga
authors.forename: R
authors.initials: R
authors.lastname: Martino
authors.forename: A
authors.initials: A
authors.lastname: Sureda
authors.forename: R
authors.initials: R
authors.lastname: Labeaga
authors.forename: S
authors.initials: S
authors.lastname: Brunet
authors.forename: J
authors.initials: J
authors.lastname: Sierra
authors.forename: N
authors.initials: N
authors.lastname: Rabella
mesh_terms: D000293:Adolescent; D000328:Adult; D000956:Antigens, Viral / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage*; D003586:Cytomegalovirus Infections / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010750:Phosphoproteins / Q000097:blood*; D014184:Transplantation, Homologous
chemical_list: D000956:Antigens, Viral; D000998:Antiviral Agents; D010750:Phosphoproteins; D015774:Ganciclovir