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.
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.
Montesinos
Pau
P
Department of Hematology, Hospital Universitario La Fe, Valencia, Spain. montesinos_pau@gva.es
Sanz
Jaime
J
Cantero
Susana
S
Lorenzo
Ignacio
I
Martín
Guillermo
G
Saavedra
Silvana
S
Palau
Javier
J
Romero
Mónica
M
Montava
Alberto
A
Senent
Leonor
L
Martínez
Jesús
J
Jarque
Isidro
I
Salavert
Miguel
M
Córdoba
Juan
J
Gómez
Lola
L
Weiss
Shirley
S
Moscardó
Federico
F
de la Rubia
Javier
J
Larrea
Luis
L
Sanz
Miguel A
MA
Sanz
Guillermo F
GF
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
D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir