Successful induction of therapeutic urinary concentration by intravenous ganciclovir and oral valganciclovir with remission of adenoviral hemorrhagic cystitis after cord blood transplantation

Abstract

AdV11-HC is one of the major complications after allogeneic HSCT in Japan. We previously reported that the intravenous infusion of ganciclovir was effective against AdV11-HC in a post-transplant patient. We here report a case of a 10-year-old boy who underwent cord blood transplantation for the treatment of relapsed lymphoblastic lymphoma. He developed AdV11-HC with an elevated AdV load in his urine and blood on day 14 after HSCT. He was immediately treated with intravenous ganciclovir; he rapidly achieved a remission of AdV11-HC with a decreased AdV load in his urine and blood. He remained in remission of AdV11-HC, even after we switched ganciclovir to oral valganciclovir on day 63. A pharmacokinetics study of his urine revealed that therapeutic concentrations of ganciclovir could be achieved by both intravenous ganciclovir and oral valganciclovir. These findings suggested that both intravenous ganciclovir and oral valganciclovir could be promising alternatives for the treatment of AdV11-HC in post-transplant patients.

Recent Advances of Acute Kidney Injury in Hematopoietic Cell Transplantation

“…The antiviral drug cidofovir is effective for hemorrhagic cystitis caused by adenovirus ( 132 , 133 ) and may be effective for hemorrhagic cystitis caused by BK virus ( 134 ). Ganciclovir ( 135 ) and valganciclovir ( 136 ) have also been reported to be effective against hemorrhagic cystitis caused by adenovirus.…”

Pharmacological Options for Viral Induced Hemorrhagic Cystitis Management: A Review of the Literature

“…The patient ultimately died 9 months post-HSCT from unrelated causes [57]. These findings suggest that ganciclovir and valganciclovir may be viable drug candidates for the treatment of ADVassociated HC in addition to being the drugs of choice for CMV-associated HC [56,57].…”

“…As a result, urine ADV rapidly declined within 12 days of therapy, and symptoms resolved on day 65 post-BMT [56]. Similarly, the use of ganciclovir followed by valganciclovir in a 9-year-old patient post-HSCT who developed hematuria 12 days after transplantation resulted in symptoms remission and ADV were absent by day 27 post-HSCT and remained undetectable in the blood and urine after stopping therapy [57]. The patient ultimately died 9 months post-HSCT from unrelated causes [57].…”

“…Similarly, the use of ganciclovir followed by valganciclovir in a 9-year-old patient post-HSCT who developed hematuria 12 days after transplantation resulted in symptoms remission and ADV were absent by day 27 post-HSCT and remained undetectable in the blood and urine after stopping therapy [57]. The patient ultimately died 9 months post-HSCT from unrelated causes [57]. These findings suggest that ganciclovir and valganciclovir may be viable drug candidates for the treatment of ADVassociated HC in addition to being the drugs of choice for CMV-associated HC [56,57].…”