title: Risk factors for treatment failures in patients receiving PCR-based preemptive therapy for CMV infection.
abstract: PCR-based preemptive therapy with ganciclovir has been shown to reduce the incidence of CMV disease after BMT. Failures of this treatment strategy are CMV disease and secondary non-viral infections. Eighty-six consecutive patients at high risk for CMV disease who received PCR-based preemptive therapy with ganciclovir were assessed for treatment failures and possible risk factors. Ganciclovir was initiated in 57 of 86 patients (66%). Only 28 of 86 (32%) patients received 4 or more weeks of ganciclovir. Recurrence of CMV infection after successful treatment was more frequent among recipients of a BMT from an unrelated compared to a sibling donor (P = 0.004). Three (3.5%) patients developed non-fatal early onset CMV disease and seven of 68 (10.3 %) late onset CMV disease (>100 days post transplant). Risk factors for late onset CMV disease were cGVHD (P = 0.0017) and duration of prior antiviral therapy >4 weeks (P = 0. 0073). The incidence of secondary non-viral infections was 28% with the duration of antiviral treatment being a significant risk factor for secondary bacterial (P = 0.0045) and invasive fungal infections (P = 0.006). Thus, PCR-based preemptive treatment with ganciclovir reduces early onset CMV disease, but the duration of antiviral therapy prior to day +100 is a significant risk factor for late onset CMV disease as well as secondary non-viral infections.
authors.affiliation: Medizinische Klinik und Poliklinik, Abt II, Tübingen, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Einsele
authors.forename: H
authors.initials: H
authors.lastname: Hebart
authors.forename: C
authors.initials: C
authors.lastname: Kauffmann-Schneider
authors.forename: C
authors.initials: C
authors.lastname: Sinzger
authors.forename: G
authors.initials: G
authors.lastname: Jahn
authors.forename: P
authors.initials: P
authors.lastname: Bader
authors.forename: T
authors.initials: T
authors.lastname: Klingebiel
authors.forename: K
authors.initials: K
authors.lastname: Dietz
authors.forename: J
authors.initials: J
authors.lastname: Löffler
authors.forename: C
authors.initials: C
authors.lastname: Bokemeyer
authors.forename: C A
authors.initials: CA
authors.lastname: Müller
authors.forename: L
authors.initials: L
authors.lastname: Kanz
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D007938:Leukemia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy; D009190:Myelodysplastic Syndromes / Q000628:therapy; D016133:Polymerase Chain Reaction / Q000379:methods; D012307:Risk Factors; D017211:Treatment Failure; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir