title: High rate of cytomegalovirus drug resistance among patients receiving preemptive antiviral treatment after haploidentical stem cell transplantation.
abstract: We examined the rate, clinical impact, and risk factors of cytomegalovirus (CMV) drug resistance in 561 patients who underwent 616 hematopoietic stem cell transplantations (HSCTs) over 5 years. Drug resistance was exclusively identified in haploidentical (haplo)-HSCT recipients receiving preemptive therapy, among whom the rate was 14.5%. Resistance appeared after prolonged treatment (median, 70 days), was associated with higher preceding viral load (P < .001), and was the strongest predictor for disease by multivariate analysis. The high rate of drug resistance as interlinked with severe disease in haplo-HSCT recipients suggests the potential advantage of prophylactic over preemptive treatment in high-risk patients and highlights the need for better-tolerable anti-CMV drugs.
authors: Clinical Virology Unit.
authors: Einat
authors: E
authors: Shmueli
authors: Reuven
authors: R
authors: Or
authors: Michael Y
authors: MY
authors: Shapira
authors: Igor B
authors: IB
authors: Resnick
authors: Orit
authors: O
authors: Caplan
authors: Tali
authors: T
authors: Bdolah-Abram
authors: Dana G
authors: DG
authors: Wolf
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000998:Antiviral Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D002648:Child; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000821:virology; D024882:Drug Resistance, Viral; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D017853:Phosphotransferases (Alcohol Group Acceptor) / Q000235:genetics; D011446:Prospective Studies
chemical_list: D000998:Antiviral Agents; D017853:Phosphotransferases (Alcohol Group Acceptor); C075365:ganciclovir kinase
keywords: antiviral drug resistance; cytomegalovirus; hematopoietic stem cell transplantation