Risk-adapted preemptive therapy for cytomegalovirus disease after allogeneic stem cell transplantation: a single-center experience in Korea.
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.
Choi
Su-Mi
SM
The Catholic Hematopoietic Stem Cell Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Lee
Dong-Gun
DG
Choi
Jung-Hyun
JH
Yoo
Jin-Hong
JH
Kim
Yoo-Jin
YJ
Park
Sun Hee
SH
Park
Sun-Nam
SN
Min
Chang-Ki
CK
Lee
Seok
S
Kim
Hee-Je
HJ
Kim
Dong-Wook
DW
Lee
Jong-Wook
JW
Min
Woo-Sung
WS
Shin
Wan-Shik
WS
Kim
Chun-Choo
CC
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
D000998:Antiviral Agents; D015774:Ganciclovir
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