title: Risk-adapted preemptive therapy for cytomegalovirus disease after allogeneic stem cell transplantation: a single-center experience in Korea.
abstract: Cytomegalovirus (CMV) remains a major cause of infection in recipients of hematopoietic stem cell transplants (HSCT) and results in significant mortality and morbidity. We present the results of CMV pp65 antigenemia-guided, risk-adapted preemptive therapy aimed at preventing CMV disease in allogeneic HSCT. Preemptive ganciclovir treatment was started when more than 5 CMV antigen-positive cells were detected in the low-risk group (with grade 0-I acute GVHD and matched related HSCT) and when any antigen-positive cells were seen in the high-risk group (with grade II-IV acute GVHD or matched unrelated HSCT). At least 1 episode of antigenemia was observed in 53 (59.6%) of 89 patients before day 100, and preemptive therapy was performed in 33 patients. CMV disease occurred in 6 patients (5 in the high-risk group and 1 in the low-risk group), and late CMV disease developed in 4 patients. Only 1 patient died of CMV pneumonitis before day 100. Neutropenia was observed in 51.5% of ganciclovir-treated patients, and coinfection/superinfection was observed in 42.4%. A strategy of ganciclovir treatment focusing on patients at higher risk could reduce the toxicity from the antiviral drug and be cost-effective. Extended surveillance for CMV disease using more sensitive diagnostic methods is necessary in high-risk patients.
authors.affiliation: The Catholic Hematopoietic Stem Cell Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Su-Mi
authors.initials: SM
authors.lastname: Choi
authors.forename: Dong-Gun
authors.initials: DG
authors.lastname: Lee
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Choi
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Yoo
authors.forename: Yoo-Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Park
authors.forename: Sun-Nam
authors.initials: SN
authors.lastname: Park
authors.forename: Chang-Ki
authors.initials: CK
authors.lastname: Min
authors.forename: Seok
authors.initials: S
authors.lastname: Lee
authors.forename: Hee-Je
authors.initials: HJ
authors.lastname: Kim
authors.forename: Dong-Wook
authors.initials: DW
authors.lastname: Kim
authors.forename: Jong-Wook
authors.initials: JW
authors.lastname: Lee
authors.forename: Woo-Sung
authors.initials: WS
authors.lastname: Min
authors.forename: Wan-Shik
authors.initials: WS
authors.lastname: Shin
authors.forename: Chun-Choo
authors.initials: CC
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000401:mortality* / Q000517:prevention & control; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage* / Q000009:adverse effects; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D007723:Korea; D008297:Male; D008875:Middle Aged; D012308:Risk Management; D014184:Transplantation, Homologous
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir
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