title: Evaluation of cytomegalovirus reactivation and tolerability in seropositive umbilical cord transplant patients after implementation of an intensive prevention strategy.
abstract: OBJECTIVE
  Cytomegalovirus (CMV) causes significant morbidity and mortality in CMV seropositive patients undergoing umbilical cord blood transplants (UCBT). Our study aimed to describe the incidence of CMV reactivation and burden of disease, as well as the tolerability of an intensive prevention strategy as compared to historical prevention.
  
  
  METHODS
  This was a retrospective chart review of 33 CMV seropositive patients that underwent UCBT. The intensive prevention strategy in UCBT consisted of ganciclovir 5mg/kg/d intravenously or valganciclovir 900mg by mouth daily initiated at the beginning of the conditioning regimen until Day -2. Then from Day -1 to Day +100, patients received valacyclovir 2g by mouth three times daily, and from Day +101 to Day +365, acyclovir 800mg by mouth twice daily. Historical standard prevention was acyclovir 800mg by mouth twice daily initiated at the beginning of the conditioning regimen until Day +365.
  
  
  RESULTS
  Thirty-three patients were included from 2008 to 2014. There were no differences in the adverse effects experienced between the two regimens (p=.4). CMV reactivation occurred significantly later with intensive prevention (p=.003). The median CMV viral titer at reactivation was lower in the intensive versus the historic prevention (1,800copies/mL and 2,700copies/mL, respectively), but was not significantly different. CMV disease occurred significantly less often in the intensive group (p=.039).
  
  
  CONCLUSIONS
  The results from this study indicate that the intensive prevention strategy was well tolerated, significantly delayed CMV reactivation, and patients had less CMV disease.
authors.affiliation: Department of Pharmacy, University of Kansas Hospital, Kansas City, KS, USA. Electronic address: mrinehart@kumc.edu.
authors.forename: Matthew
authors.initials: M
authors.lastname: Rinehart
authors.affiliation: Department of Pharmacy, University of Kansas Hospital, Kansas City, KS, USA.
authors.forename: Erica
authors.initials: E
authors.lastname: Hochard
authors.affiliation: Department of Pharmacy, University of Kansas Hospital, Kansas City, KS, USA; University of Kansas School of Pharmacy, Lawrence, KS, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Rockey
authors.affiliation: Department of Blood and Marrow Transplant, University of Kansas Hospital, Kansas City, KS, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Abhyankar
authors.affiliation: Department of Blood and Marrow Transplant, University of Kansas Hospital, Kansas City, KS, USA.
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Ganguly
authors.affiliation: Department of Blood and Marrow Transplant, University of Kansas Hospital, Kansas City, KS, USA.
authors.forename: Tara
authors.initials: T
authors.lastname: Lin
authors.affiliation: Department of Blood and Marrow Transplant, University of Kansas Hospital, Kansas City, KS, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: McGuirk
authors.affiliation: Department of Blood and Marrow Transplant, University of Kansas Hospital, Kansas City, KS, USA.
authors.forename: Leyla
authors.initials: L
authors.lastname: Shune
authors.affiliation: Department of Blood and Marrow Transplant, University of Kansas Hospital, Kansas City, KS, USA.
authors.forename: Anurag
authors.initials: A
authors.lastname: Singh
authors.affiliation: Department of Blood and Marrow Transplant, University of Kansas Hospital, Kansas City, KS, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Aljitawi
mesh_terms: D000328:Adult; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects; D003587:Cytomegalovirus / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000097:blood / Q000517:prevention & control* / Q000628:therapy* / Q000821:virology; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D014775:Virus Activation / Q000502:physiology*
keywords: CMV disease; CMV reactivation; CMV viremia; Cytomegalovirus; Intensive prevention; Umbilical cord blood transplant