Cytomegalovirus disease in adult marrow transplant recipients receiving ganciclovir prophylaxis: a retrospective study.
In a retrospective study, we compared the incidence and risk of mortality associated with CMV disease in adult allogeneic BMT and PBSC recipients who received ganciclovir prophylaxis three-times-per-week (78 patients) vs five-times-per-week (137 patients). Active CMV infection occurred in 28 (41%) and 26 (21%) in the three- vs five-times-per-week groups, respectively (P < 0.005). CMV disease developed in 11 (16%) and five (4%) patients who received ganciclovir prophylaxis in the three-times-per-week vs five-times-per-week groups (P < 0.004). The CMV-attributable mortality rate was 1.5% and 12% in the five- vsthree-times-per-week groups, respectively (P < 0.003). Risk factors for CMV disease, significant at the P < 0.05 level in the multivariate analysis, were ganciclovir prophylaxis at three-times-per-week, receiving a T cell-depleted (TCD) marrow, and tacrolimus as prophylaxis for GVHD. These data suggest that ganciclovir five-times-per-week significantly reduced the incidence and mortality of CMV disease in allogeneic BMT and PBSC recipients. However, ganciclovir five-times-per-week was less effective for the prevention of CMV disease in patients receiving TCD marrow or tacrolimus.
Maltezou
H
H
Section of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Whimbey
E
E
Abi-Said
D
D
Przepiorka
D
D
Champlin
R
R
Goodrich
J
J
Maltazou
H
H
Champlain
R
R
D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000401:mortality; D003586:Cytomegalovirus Infections / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
D000998:Antiviral Agents; D015774:Ganciclovir