title: Initial low-dose valganciclovir as a preemptive therapy is effective for cytomegalovirus infection in allogeneic hematopoietic stem cell transplant recipients.
abstract: Preemptive therapy for cytomegalovirus (CMV) infection in allogeneic hematopoietic stem cell transplant (HSCT) patients is effective in decreasing the incidence of CMV disease. Intravenous ganciclovir is a commonly used preemptive therapy, but as we have recently shown, oral valganciclovir (VGC) is a useful alternative. However, the optimal dose of VGC has not been determined. We prospectively evaluated the efficacy and toxicity of an initial low-dose of VGC (900 mg QD) as preemptive therapy in 20 patients with low-level CMV antigenemia following allogeneic HSCT. Patients were screened weekly for CMV pp65 antigenemia after engraftment. Preemptive therapy with VGC (900 mg QD) was initiated if more than two CMV antigen-positive cells per 50,000 leukocytes were detected. CMV antigen-positive cells disappeared from all 20 patients after 14-29 days (median 20 days) of VGC treatment. None of the patients developed CMV disease nor did they require more than the conventional VGC dose (900 mg BID). Neutropenia (<500/μL) developed in three patients who required granulocyte-colony-stimulating factor support, but there were no other significant side effects. These observations suggest that the initial dose of VGC in preemptive therapy for CMV can be safely decreased to 900 mg QD for patients with low-level CMV antigenemia.
authors.affiliation: Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan. takenaka@intmed1.med.kyushu-u.ac.jp
authors.forename: Katsuto
authors.initials: K
authors.lastname: Takenaka
authors.forename: Koji
authors.initials: K
authors.lastname: Nagafuji
authors.forename: Ken
authors.initials: K
authors.lastname: Takase
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Kamimura
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Mori
authors.forename: Yoshikiyo
authors.initials: Y
authors.lastname: Ito
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Nishi
authors.forename: Hideho
authors.initials: H
authors.lastname: Henzan
authors.forename: Koji
authors.initials: K
authors.lastname: Kato
authors.forename: Naoki
authors.initials: N
authors.lastname: Harada
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Eto
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Takanori
authors.initials: T
authors.lastname: Teshima
authors.forename: Koichi
authors.initials: K
authors.lastname: Akashi
mesh_terms: D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000821:virology; D015774:Ganciclovir / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008875:Middle Aged; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir