Preemptive therapy with ganciclovir 5 mg/kg once daily for cytomegalovirus infection after unrelated cord blood transplantation

Abstract

The efficacy and safety of preemptive therapy using ganciclovir (GCV) 5 mg/kg once daily for CMV infection after unrelated cord blood transplantation (CBT) were studied. The initial preemptive therapy with GCV 5 mg/kg once daily led to resolution of CMV antigenemia in 25 of 34 patients (74%). In the remaining 9 patients (26%), antigenemia resolved after dose-escalation of GCV or change to foscarnet therapy. Recurrence of antigenemia was seen in 18 patients (53%). A total of 12 patients received the second preemptive therapy with GCV 5 mg/ kg once daily, which led to resolution of antigenemia in 11 of 12 patients (92%). The remaining 1 patient (8%) required change to foscarnet therapy. None of 34 patients developed CMV disease. Neutropenia with an absolute neutrophil number of less than 1 and 0.5 Â 10 9 per liter after GCV therapy occurred in 12 (35%) and 1 (3%) patients, respectively, after the initial therapy, and in 2 (17%) and 0 (0%) patients, respectively, after the second therapy. No patients developed neutropenic fever or secondary graft failure after GCV therapy. There were no deaths directly attributable to GCV therapy. The present study suggests that antigenemia-based preemptive strategy using GCV 5 mg/kg once daily is feasible and effective for CBT recipients.

Cytomegalovirus in Hematopoietic Stem Cell Transplant Recipients

“…Among CMV-seropositive recipients who do not receive antiviral prophylaxis, the rate of CMV infection after CBT is 40% to 80%, with one study reporting 100%. 94–98 When patients receive prophylaxis with high-dose valacyclovir after CBT, it does not seem that CBT entails a significantly greater risk of CMV infection and disease than does peripheral blood stem cell or bone marrow transplantation. 89 …”

Cytomegalovirus in Hematopoietic Stem Cell Transplant Recipients

“…One study described successful preemptive treatment with ganciclovir, 98 whereas another combined high-dose valacyclovir prophylaxis with continued monitoring and preemptive therapy. 89 …”

“…Among CMV-seropositive recipients who do not receive antiviral prophylaxis, the rate of CMV infection after CBT is 40% to 80%, with one study reporting 100%. [94][95][96][97][98] When patients receive prophylaxis with high-dose valacyclovir after CBT, it does not seem that CBT entails a significantly greater risk of CMV infection and disease than does peripheral blood stem cell or bone marrow transplantation. 89 Alemtuzumab is an anti-CD52 monoclonal antibody that results in CD41 and CD81 lymphopenia that can last for up to 9 months after administration.…”

Half‐dose ganciclovir preemptive treatment of cytomegalovirus infection after pediatric allogeneic hematopoietic stem cell transplantation

“…Recent studies of adults undergoing HSCT have shown that halving GCV dosage is a promising strategy for preemptive treatment of CMV infection . However, no corresponding studies have been performed in pediatric patients as yet.…”