title: Pre-transplant ganciclovir and post transplant high-dose valacyclovir reduce CMV infections after alemtuzumab-based conditioning.
abstract: Alemtuzumab (Campath-1H)-based conditioning regimens are effective in preventing GVHD, but are associated with very high rates of cytomegalovirus (CMV) infection, a major limitation to their use. We evaluated 85 patients receiving conditioning with fludarabine 30 mg/m2/day (day -7 to day -3), alemtuzumab 20 mg/day (day -7 to day -3), and melphalan 140 mg/m2 on day -2. The initial patients received post transplant CMV prophylaxis with high-dose acyclovir. A very high incidence of CMV viremia was observed as has been commonly reported after alemtuzumab-based conditioning. Sixty-seven subsequent patients received pre-transplant ganciclovir and high-dose valacyclovir after engraftment. The cumulative incidence of CMV infection in the valacyclovir cohort was 29%. This compared favorably to the cumulative incidence of 53% in patients receiving only acyclovir (P = 0.004) and to literature data. CMV prophylaxis with pre-transplant ganciclovir and high-dose valacyclovir after engraftment appears effective in preventing the excessive incidence of CMV infection after alemtuzumab-based conditioning regimens.
authors.affiliation: Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA.
authors.forename: J
authors.initials: J
authors.lastname: Kline
authors.forename: D A
authors.initials: DA
authors.lastname: Pollyea
authors.forename: W
authors.initials: W
authors.lastname: Stock
authors.forename: A
authors.initials: A
authors.lastname: Artz
authors.forename: E
authors.initials: E
authors.lastname: Rich
authors.forename: L
authors.initials: L
authors.lastname: Godley
authors.forename: T
authors.initials: T
authors.lastname: Zimmerman
authors.forename: K
authors.initials: K
authors.lastname: Thompson
authors.forename: K
authors.initials: K
authors.lastname: Pursell
authors.forename: R A
authors.initials: RA
authors.lastname: Larson
authors.forename: K
authors.initials: K
authors.lastname: van Besien
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000998:Antiviral Agents / Q000008:administration & dosage*; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D003586:Cytomegalovirus Infections / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage*; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D000077483:Valacyclovir; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000970:Antineoplastic Agents; D000998:Antiviral Agents; D000074323:Alemtuzumab; D014633:Valine; D000077483:Valacyclovir; D015774:Ganciclovir; D000212:Acyclovir