title: The impact of pre-transplant valganciclovir on early cytomegalovirus reactivation after allogeneic hematopoietic stem cell transplantation.
abstract: Cytomegalovirus reactivation is a common complication of allogeneic hematopoietic stem cell transplant. The use of pre-transplant valganciclovir during the conditioning regimen followed by preemptive therapy has been used in an attempt to reduce the rate of early cytomegalovirus reactivation, but efficacy data are lacking. In this retrospective study, we evaluated the impact of pre-transplant valganciclovir during the conditioning regimen followed by a preemptive approach on the rate of early cytomegalovirus reactivation through day 100. The rate of cytomegalovirus reactivation through day 100 was 41% in the no-valganciclovir group compared to 46% in the valganciclovir group (p = 0.4). Interestingly, median time to cytomegalovirus reactivation was earlier in the no-valganciclovir group compared to the valganciclovir group (26 vs. 34 days; p = 0.008) and there was a trend toward a higher rate of cytomegalovirus disease through day 100 in the no-valganciclovir group (0.7% valganciclovir vs. 4% no-valganciclovir; p = 0.1). Day 100 survival was similar between the groups (90% valganciclovir vs. 91% no-valganciclovir; p = 0.8). Although the time to cytomegalovirus reactivation is significantly longer in the valganciclovir group, this did not impact the rate of cytomegalovirus reactivation or survival by day 100 suggesting that other strategies need to be explored.
authors.affiliation: Department of Pharmacy, The University of Texas MD Anderson Cancer Center, USA klwilhelm@mdanderson.org.
authors.forename: Kaci
authors.initials: K
authors.lastname: Wilhelm
authors.affiliation: Department of Infectious Disease, The University of Texas MD Anderson Cancer Center, USA.
authors.forename: Roy
authors.initials: R
authors.lastname: Chemaly
authors.affiliation: Department of Stem Cell Transplant and Cellular Therapy, The University of Texas MD Anderson Cancer Center, USA.
authors.forename: Rima
authors.initials: R
authors.lastname: Saliba
authors.affiliation: Department of Pharmacy, The University of Texas MD Anderson Cancer Center, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Gulbis
authors.affiliation: Department of Pharmacy, The University of Texas MD Anderson Cancer Center, USA.
authors.forename: Ila
authors.initials: I
authors.lastname: Saunders
authors.affiliation: Department of Pharmacy, The University of Texas MD Anderson Cancer Center, USA.
authors.forename: Rita
authors.initials: R
authors.lastname: Cool
authors.affiliation: Department of Pharmacy, The University of Texas MD Anderson Cancer Center, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Ferguson
authors.affiliation: Department of Pharmacy, The University of Texas MD Anderson Cancer Center, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Westmoreland
authors.affiliation: Department of Stem Cell Transplant and Cellular Therapy, The University of Texas MD Anderson Cancer Center, USA.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Rondon
authors.affiliation: Department of Stem Cell Transplant and Cellular Therapy, The University of Texas MD Anderson Cancer Center, USA.
authors.forename: Partow
authors.initials: P
authors.lastname: Kebriaei
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D000077562:Valganciclovir; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: Cytomegalovirus; allogeneic stem cell transplant; valganciclovir