title: Use of foscarnet for cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation from a related donor.
abstract: Foscarnet is an active agent against cytomegalovirus (CMV) infection after hematopoietic stem cell transplantation (HSCT), as well as ganciclovir. We investigated the usefulness of foscarnet in patients who underwent related allogeneic HSCT. Foscarnet was used in 320 patients with a median age of 45 years (range 15-72). The purpose of administration was CMV disease in 65, preemptive use in 248 and prophylaxis in 7. Totally, 194 patients had a history of prior ganciclovir treatment. The reason for foscarnet use was insufficient therapeutic effect of prior ganciclovir in 99, and adverse event including myelosuppression in 95. The response rate in symptom was 52% for the CMV disease patients. Antigenemia disappeared in 77% of the preemptive treatment and improved in 13% of the patients. No outbreak of CMV disease was recognized. The total effectiveness of therapeutic and preemptive use was significantly higher for patients without prior ganciclovir (91 vs. 76%, P = 0.001). Adverse events of grade 3 or higher were recognized in 24%, including electrolyte abnormalities in 11%, neutropenia in 8%, and thrombocytopenia in 8%. Renal damage was only observed in 3% of patients. Foscarnet was concluded to be a safe and effective anti-CMV agent and to be a suitable alternative to ganciclovir.
authors.affiliation: Department of HSCT Data Management and Biostatistics, Nagoya University School of Medicine, Higashi-ku, Nagoya, Japan.
authors.forename: Maiko
authors.initials: M
authors.lastname: Asakura
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ikegame
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yoshihara
authors.forename: Shuichi
authors.initials: S
authors.lastname: Taniguchi
authors.forename: Takehiko
authors.initials: T
authors.lastname: Mori
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Etoh
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Takami
authors.forename: Takashi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fukuda
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hatanaka
authors.forename: Heiwa
authors.initials: H
authors.lastname: Kanamori
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Yujiri
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Atsuta
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
authors.forename: Ritsuro
authors.initials: R
authors.lastname: Suzuki
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000517:prevention & control; D004341:Drug Evaluation; D005190:Family; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use*; D015774:Ganciclovir / Q000627:therapeutic use; D006402:Hematologic Diseases / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018894:Reverse Transcriptase Inhibitors; D017245:Foscarnet; D015774:Ganciclovir