title: Incidence, risk factors, and outcome of cytomegalovirus infection and disease in patients receiving prophylaxis with oral valganciclovir or intravenous ganciclovir after umbilical cord blood transplantation.
abstract: There is no information on the efficacy and safety of anticytomegalovirus (CMV) prophylaxis with intravenous ganciclovir or oral valganciclovir after unrelated cord-blood transplantation (UCBT). This issue was addressed in 151 adults (117 CMV-seropositive) undergoing UCBT at a single institution. The first 38 CMV-seropositive recipients were assigned to receive prophylactic ganciclovir, and the next 79 were given valganciclovir after engraftment. The cumulative incidence (CI) of CMV infection and disease was similar in patients receiving valganciclovir or ganciclovir (59% versus 55%, P = .59; and 9% versus 18%, P = .33, respectively). The toxicity profile and CI of nonrelapse mortality (CMV) and infection-related mortality did not differ between drugs. Patients receiving valganciclovir required fewer visits to the day hospital (P = .04). The CI of CMV infection and disease in 34 CMV-seronegative recipients was 12% and 6%, indicating that tight CMV monitoring is mandatory in this subset. The recipient's CMV serostatus, acute and extensive chronic graft-versus-host disease (aGVHD, cGVHD) were the main risk factors for CMV infection, and aGVHD for CMV disease. This study suggests that prophylaxis with oral valganciclovir is as safe and effective as intravenous ganciclovir for preventing CMV infection and disease after UCBT, but valganciclovir reduces the use of hospital resources.
authors.affiliation: Department of Hematology, Hospital Universitario La Fe, Valencia, Spain. montesinos_pau@gva.es
authors.forename: Pau
authors.initials: P
authors.lastname: Montesinos
authors.forename: Jaime
authors.initials: J
authors.lastname: Sanz
authors.forename: Susana
authors.initials: S
authors.lastname: Cantero
authors.forename: Ignacio
authors.initials: I
authors.lastname: Lorenzo
authors.forename: Guillermo
authors.initials: G
authors.lastname: Martín
authors.forename: Silvana
authors.initials: S
authors.lastname: Saavedra
authors.forename: Javier
authors.initials: J
authors.lastname: Palau
authors.forename: Mónica
authors.initials: M
authors.lastname: Romero
authors.forename: Alberto
authors.initials: A
authors.lastname: Montava
authors.forename: Leonor
authors.initials: L
authors.lastname: Senent
authors.forename: Jesús
authors.initials: J
authors.lastname: Martínez
authors.forename: Isidro
authors.initials: I
authors.lastname: Jarque
authors.forename: Miguel
authors.initials: M
authors.lastname: Salavert
authors.forename: Juan
authors.initials: J
authors.lastname: Córdoba
authors.forename: Lola
authors.initials: L
authors.lastname: Gómez
authors.forename: Shirley
authors.initials: S
authors.lastname: Weiss
authors.forename: Federico
authors.initials: F
authors.lastname: Moscardó
authors.forename: Javier
authors.initials: J
authors.lastname: de la Rubia
authors.forename: Luis
authors.initials: L
authors.lastname: Larrea
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Sanz
authors.forename: Guillermo F
authors.initials: GF
authors.lastname: Sanz
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D036101:Cord Blood Stem Cell Transplantation; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000517:prevention & control; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D006086:Graft vs Host Disease / Q000453:epidemiology; D006295:Health Resources / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011292:Premedication; D011379:Prognosis; D012307:Risk Factors; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D000077562:Valganciclovir; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir