title: Use of Valacyclovir for the treatment of cytomegalovirus antigenemia after hematopoietic stem cell transplantation.
abstract: BACKGROUND
  Valacyclovir has been used for prophylaxis against cytomegalovirus (CMV) infection after hematopoietic stem cell transplantation (HSCT). We investigated the efficacy and safety of high-dose Valacyclovir as pre-emptive therapy in patients with CMV antigenemia after HSCT.
  
  
  METHODS
  In a retrospective single center study of 61 patients, we compared the rates of viral clearance, recurrent antigenemia and adverse events in patients with pp65 CMV antigenemia who received high dose Valacyclovir (n = 15), Valganciclovir (n = 16), and Foscarnet (n = 30).
  
  
  RESULTS
  Overall, 60/61 (98 %) of cases achieved CMV antigenemia clearance by day 28, and no patient developed CMV disease. After adjusting for age, sex, diagnosis, CMV serological status, donor type, CMV antigen level, graft-versus-host disease (GVHD) therapy, and conditioning regimen, there were no significant differences in the rates of viral clearance at day 14 in patients who received Valganciclovir (0.18, 95 % confidence interval (CI) 0.01 to 2.15, p = 0.17) and Foscarnet (OR 0.22, 95 % CI 0.03 to 2.40, p = 0.22), compared with Valacyclovir (assigned OR = 1.00). Recurrent antigenemia by day 180 after clearance of the initial CMV episode occurred in 34/61 (56 %) of patients. Using the multivariate model adjusting for the same covariates, there were also no significant differences in secondary episodes of CMV between treatment groups. With regards to adverse effect monitoring, Foscarnet led to significantly increased creatinine levels (P = 0.009), while Valganciclovir led to significant decrease in neutrophil counts (P = 0.012).
  
  
  CONCLUSIONS
  High dose Valacyclovir is a potential alternative to Valganciclovir and Foscarnet in the stable post-HSCT patient who has cytopenia and is not keen for inpatient treatment of CMV antigenemia.
authors.affiliation: Department of Hematology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Shin-Yeu
authors.initials: SY
authors.lastname: Ong
authors.affiliation: Department of Hematology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Ha-Thi-Thu
authors.initials: HT
authors.lastname: Truong
authors.affiliation: Department of Hematology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Colin Phipps
authors.initials: CP
authors.lastname: Diong
authors.affiliation: Department of Hematology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Yeh-Ching
authors.initials: YC
authors.lastname: Linn
authors.affiliation: Department of Hematology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Aloysius Yew-Leng
authors.initials: AY
authors.lastname: Ho
authors.affiliation: Department of Hematology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Yeow-Tee
authors.initials: YT
authors.lastname: Goh
authors.affiliation: Department of Hematology, Singapore General Hospital, Singapore, Singapore.
authors.forename: William Ying-Khee
authors.initials: WY
authors.lastname: Hwang