title: Outcomes in Transplant Recipients Treated With Foscarnet for Ganciclovir-Resistant or Refractory Cytomegalovirus Infection.
abstract: Antiviral-resistant or refractory cytomegalovirus (CMV) infection is challenging, and salvage therapies, foscarnet, and cidofovir, have significant toxicities. Several investigational anti-CMV agents are under development, but more information is needed on outcomes of current treatments to facilitate clinical trial design for new drugs.
  
  
  
  Records of solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients at a single center over a 10-year period were reviewed retrospectively to characterize those who had received foscarnet treatment for ganciclovir-resistant or refractory CMV infection. Data were collected on virologic responses, mortality, and nephrotoxicity.
  
  
  
  Of 39 patients (22 SOT, 17 HCT), 15 had documented ganciclovir resistance mutations and 11 (28%) of 39 had tissue-invasive CMV. Median duration of foscarnet was 32 days. Virologic failure occurred in 13 (33%) of 39 and relapses of viremia occurred in 31%. Mortality was 12 (31%) of 39 and was higher in HCT than SOT (P = 0.001), although ganciclovir resistance was more common in SOT (P = 0.003). Doses of ganciclovir or valganciclovir were low in 10 (26%) of 39 at some time before switching to foscarnet. Renal dysfunction occurred in 20 (51%) of 39 by end of treatment and in 7 (28%) of 25 after 6 months.
  
  
  
  Outcomes of existing treatment for ganciclovir-resistant or refractory CMV are suboptimal, in terms of virologic clearance, renal dysfunction, and mortality. These data should provide background information for future clinical trials of newer antiviral agents.
authors: 1 Division of Infectious Diseases, Department of Medicine Johns Hopkins, Baltimore, MD. 2 The Eudowood Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins, Baltimore, MD. 3 Division of Nephrology, Department of Medicine, Johns Hopkins, Baltimore, MD. 4 Department of Pharmacy, Johns Hopkins, Baltimore, MD. 5 Division of Pulmonary and Critical Care, Department of Medicine Johns Hopkins, Baltimore, MD. 6 The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD. 7 Division of Medical Microbiology, Department of Pathology, Johns Hopkins, Baltimore, MD.
authors: Robin K
authors: RK
authors: Avery
authors: Ravit
authors: R
authors: Arav-Boger
authors: Kieren A
authors: KA
authors: Marr
authors: Edward
authors: E
authors: Kraus
authors: Shmuel
authors: S
authors: Shoham
authors: Laura
authors: L
authors: Lees
authors: Brandon
authors: B
authors: Trollinger
authors: Pali
authors: P
authors: Shah
authors: Rich
authors: R
authors: Ambinder
authors: Dionysios
authors: D
authors: Neofytos
authors: Darin
authors: D
authors: Ostrander
authors: Michael
authors: M
authors: Forman
authors: Alexandra
authors: A
authors: Valsamakis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D024882:Drug Resistance, Viral; D005260:Female; D017245:Foscarnet / Q000009:adverse effects / Q000627:therapeutic use*; D015774:Ganciclovir / Q000009:adverse effects / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D066027:Transplant Recipients
chemical_list: D000998:Antiviral Agents; D017245:Foscarnet; D015774:Ganciclovir