title: Reduced dose of foscarnet as preemptive therapy for cytomegalovirus infection following reduced-intensity cord blood transplantation.
abstract: Although foscarnet is a promising alternative for the treatment of cytomegalovirus (CMV) infection, its toxicity can be significant in patients with advanced age. We retrospectively reviewed medical records of 123 patients (median age of 55; range, 17-79) who received reduced-intensity cord blood transplantation (RI-CBT). Patients preemptively received reduced-dose foscarnet 30 mg/kg twice daily when CMV antigenemia exceeded 10/50,000. Sixty-three patients developed CMV antigenemia on a median of day 34, and 29 received foscarnet preemptively. The median level of CMV antigenemia at the initiation of foscarnet was 30. Median duration of foscarnet administration was 24 days. Adverse effects included electrolyte abnormalities (n=19), renal impairment (n=13), and skin eruption requiring discontinuation of foscarnet (n=1). Preemptive therapy of foscarnet was completed in 18 patients. Seven patients died during foscarnet use without developing CMV disease. The remaining 3 developed CMV enterocolitis 5, 14, and 17 days after initiation of foscarnet. All of them were successfully treated with ganciclovir or foscarnet. Reduced dose of foscarnet is beneficial to control CMV reactivation following RI-CBT; however, it has considerable toxicities in RI-CBT recipients with advanced age. Further studies are warranted to minimize toxicities and identify optimal dosages.
authors.affiliation: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Narimatsu
authors.forename: M
authors.initials: M
authors.lastname: Kami
authors.forename: D
authors.initials: D
authors.lastname: Kato
authors.forename: T
authors.initials: T
authors.lastname: Matsumura
authors.forename: N
authors.initials: N
authors.lastname: Murashige
authors.forename: E
authors.initials: E
authors.lastname: Kusumi
authors.forename: K
authors.initials: K
authors.lastname: Yuji
authors.forename: A
authors.initials: A
authors.lastname: Hori
authors.forename: T
authors.initials: T
authors.lastname: Shibata
authors.forename: K
authors.initials: K
authors.lastname: Masuoka
authors.forename: A
authors.initials: A
authors.lastname: Wake
authors.forename: S
authors.initials: S
authors.lastname: Miyakoshi
authors.forename: S
authors.initials: S
authors.lastname: Morinaga
authors.forename: S
authors.initials: S
authors.lastname: Taniguchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000956:Antigens, Viral / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage*; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D003587:Cytomegalovirus / Q000276:immunology / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000097:blood / Q000188:drug therapy* / Q000517:prevention & control*; D004760:Enterocolitis / Q000188:drug therapy / Q000209:etiology; D005076:Exanthema / Q000139:chemically induced; D005260:Female; D017245:Foscarnet / Q000008:administration & dosage*; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D011183:Postoperative Complications; D051437:Renal Insufficiency / Q000139:chemically induced; D012189:Retrospective Studies; D016896:Treatment Outcome; D014883:Water-Electrolyte Imbalance / Q000139:chemically induced
chemical_list: D000956:Antigens, Viral; D000998:Antiviral Agents; D017245:Foscarnet; D015774:Ganciclovir