Low-Dose Valganciclovir as Preemptive Therapy for Cytomegalovirus Infection Occurring in Allogeneic Stem Cell Transplant Recipients

Abstract

Few data are available to date on the dose of oral valganciclovir as cytomegalovirus (CMV) preemptive therapy in stem cell transplantation patients. This study aimed to evaluate the efficacy and safety of low-dose valganciclovir (900 mg/day) as preemptive treatment in allotransplanted recipients. Valganciclovir was used in 34 patients who underwent allogeneic stem cell transplantation for hematological malignancies at the dose of 900 mg oral administration/day (12 patients, group 1) or 1,800 mg oral administration/day (22 patients, group 2). Thirty-two out of 34 patients (94%) obtained negativization of polymerase chain reaction for CMV at a median of 12.5 days from the beginning of valganciclovir administration (10/12 patients of group 1, 22/22 patients of group 2). We conclude that oral administration of valganciclovir can induce clearance of CMV viral load in about 2 weeks; moreover, lower-dose oral valganciclovir (900 mg/day) has a comparable efficacy to the proposed standard dose (1,800 mg/day).

Occurrence of adverse events caused by valganciclovir as pre‐emptive therapy for cytomegalovirus infection after allogeneic stem cell transplantation is reduced by low‐dose administration

“…In this study, the incidences of toxicities including neutropenia and thrombocytopenia were higher in HSCT recipients who received standard-dose VGCV pre-emptive therapy than in HSCT recipients who received low-dose VGCV. Several studies have shown that the clinical efficacy of low-dose VGCV pre-emptive Non-hematologic 2 0 0.22 Table 2 therapy was equivalent to that of standard-dose VGCV for CMV infection; however, no significant difference in the frequency of toxicity between the 2 groups was reported (10,11). The subjects in our study included generally underweight Japanese patients compared to non-Asian patients, indicating the possibility that an excessive dose based on weight induced a high frequency of side effects in the standard-dose group in previous studies.…”

Profilaxis de citomegalovirus en niños y adultos sometidos a trasplante de órganos sólidos y de precursores hematopoyéticos

“…Los antivirales que pueden ser usados son ganciclovir iv (A1), y nuevas publicaciones también avalan el uso de valganciclovir oral en caso de que el paciente esté en condiciones de deglutir y no presente diarrea ni mucositis 26,27 . (Tabla 3.a).…”

CMV in Hematopoietic Stem Cell Transplantation

“… 22 Moreover, finally, the threshold used to start preemptive therapy shows an enormous variation from center to center (100, 200, 500, 600, 1000, 10,000, 50,000 copies/ml, to put some examples). 22 , 85 – 90 …”