title: Low-dose valgancyclovir as cytomegalovirus reactivation prophylaxis in allogeneic haematopoietic stem cell transplantation.
abstract: The efficacy and safety of low dose oral valgancyclovir (VGCV) as cytomegalovirus (CMV) reactivation prophylaxis was retrospectively evaluated in 32 consecutive patients which underwent allogeneic HLA-matched related and unrelated hematopoietic stem cell transplantation (HSCT).   Thirty HSCT recipients showed pretransplant CMV seropositivity. Fifteen received a myeloablative conditioning regimen, while seventeen patients received a reduced-intensity conditioning regimen. Twenty-one patients received graft-versus-host disease (GVHD) prophylaxis with cyclosporin A (CsA) and methotrexate (MTX), and the others CsA with MTX and anti-thymocyte globulin. CMV infection was monitored weekly using polymerase chain reaction (PCR). VGCV was administered orally at a dose of 450 mg daily for six months.  Six patients developed a positive CMV-PCR on average 56 days after HSCT successfully treated with VGCV at 1800 mg/day, except one who developed fatal gastrointestinal CMV disease. At the time of CMV reactivation, four patients had been affected by grade II-IV acute GVHD and two by an extensive chronic GVHD. No significant specific VGCV-related toxicity was encountered. Seven patients presented hematological toxicity which did not require drug discontinuation.  Our data suggest that low dose VGCV is safe and effective as  CMV reactivation prophylaxis in allogeneic HSCT recipients. These results require further validation in prospective randomized studies.
authors.affiliation: Hematology, Oncology, Pathology and Infectious Disease Branch, Department of Medicine, University of Salerno, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Serio
authors.forename: R
authors.initials: R
authors.lastname: Rosamilio
authors.forename: V
authors.initials: V
authors.lastname: Giudice
authors.forename: S
authors.initials: S
authors.lastname: Pepe
authors.forename: P
authors.initials: P
authors.lastname: Zeppa
authors.forename: S
authors.initials: S
authors.lastname: Esposiito
authors.forename: L
authors.initials: L
authors.lastname: Pezzullo
authors.forename: M
authors.initials: M
authors.lastname: Rocco
authors.forename: N
authors.initials: N
authors.lastname: Montuori
authors.forename: C
authors.initials: C
authors.lastname: Selleri
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000494:pharmacology; D003587:Cytomegalovirus / Q000187:drug effects* / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000077562:Valganciclovir; D014775:Virus Activation / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir