[Cytomegalovirus detection in blood and bronchoalveolar lavage, and prophylaxis or preemptive treatment with ganciclovir in children with allogeneic stem cell transplantation].
BACKGROUND
Cytomegalovirus disease is one of the complications of allogeneic stem cell transplantation (SCT). The objective of this study was to determine the frequency of CMV infection and CMV disease in children undergoing allogeneic SCT, and in whom antigenemia and bronchoalveolar lavage (BAL) were performed for early detection of CMV infection.


METHODS
A total of 59 consecutive children who underwent allogeneic-identical, related SCT were prospectively evaluated. The patients were classified into: group 1 (low risk), donor and recipient CMV-seronegative; group 2 (intermediate risk), donor and/or recipient CMV-seropositive; and group 3 (high risk), recipient with acute graft-versus-host disease (GVHD) resistant to steroid therapy. Weekly antigenemia was carried out in all the patients until day 1100. In antigenemia-negative patients in group 2, BAL was performed on day 145. Patients in groups 1 and 2 with positive antigenemia or BAL received ganciclovir until day 1100. In group-3 children, ganciclovir was given until GVHD was controlled.


RESULTS
The frequency of CMV infection and CMV disease was 45% and 1.5%, respectively. Testing for CMV in BAL in group-2 patients increased the frequency of early diagnosis by 10%. Ganciclovir was administered to 57% of the patients in this study.


CONCLUSIONS
As compared to other series, a lower frequency of CMV disease and a reduction in ganciclovir use were observed with this strategy.
Figueroa
Carlos
C
Servicio de Hematología y Oncología, Hospital de Pediatría Profesor Dr. Juan P. Garrahan, Buenos Aires, Argentina. cfigueroa@garrahan.gov.ar
Bonduel
Mariana
M
Paganini
Hugo
H
Botto
Hugo
H
Casimir
Lidia
L
D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001769:Blood / Q000821:virology; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D033581:Stem Cell Transplantation; D014184:Transplantation, Homologous
D000998:Antiviral Agents; D015774:Ganciclovir