[Impact of initial cytomegalovirus viral load on efficacy of preemptive therapy with ganciclovir in allogeneic stem cell transplant recipients].
OBJECTIVE
To study the impact of initial cytomegalovirus (CMV) viral load on virological response to ganciclovir preemptive therapy in allogeneic stem cell transplant (SCT) recipients after 4 weeks of treatment.


METHODS
Eighty-one consecutive allogeneic SCT recipients were included. Preemptive therapy was initiated when CMV load was positive for 2 consecutive weeks or when a viral load >5000copies/mL was detected in 1 sample. If viral load was >400copies/mL after 2 weeks of treatment, maintenance treatment with ganciclovir was continued for 2 additional weeks. Virological failure was defined as a CMV load >400copies/mL after 4 weeks of treatment.


RESULTS
Ganciclovir preemptive therapy was initiated in 32 patients (39.5%) who had 39 episodes of CMV replication. Virological failure occurred in 16 patients (50%) after 18 episodes of replication (46%). Clinical failure additionally occurred in 2 episodes (5%). The only risk factor for virological failure was a peak viral load >20,000copies/mL at the beginning of treatment (OR 5.88; 95% CI: 1.49-25, P=.03). The main risk factor for CMV replication >20,000copies/mL at the start of treatment was the presence of grade II-IV acute graft-versus-host-disease (OR 16; 95% CI: 8.5-45).


CONCLUSIONS
CMV viral load >20,000copies/mL is the main risk factor for virological failure after 4 weeks of ganciclovir preemptive therapy following SCT.
Torre-Cisneros
Julián
J
Unidad Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, España. julian.torre.sspa@juntadeandalucia.es
Caston-Osorio
Juan José
JJ
Martín
Carmen
C
Rivero
Antonio
A
Doblas
Antonio
A
Rojas
Rafael
R
Gómez
Pedro
P
Martínez
Francisco
F
Torres
Antonio
A
D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology; D003586:Cytomegalovirus Infections / Q000097:blood / Q000188:drug therapy* / Q000517:prevention & control / Q000821:virology; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy; D011183:Postoperative Complications / Q000517:prevention & control* / Q000821:virology; D011292:Premedication; D014184:Transplantation, Homologous; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy*; D014775:Virus Activation / Q000187:drug effects; D014779:Virus Replication / Q000187:drug effects*; D055815:Young Adult
D000998:Antiviral Agents; D004279:DNA, Viral; D016179:Granulocyte Colony-Stimulating Factor; D015774:Ganciclovir