Prophylactic pretransplant ganciclovir to reduce cytomegalovirus infection after hematopoietic stem cell transplantation
Objective/Background: Cytomegalovirus (CMV) reactivation remains a serious complication after allogeneic hematopoietic cell transplantation (HCT) occurring in approximately 60–70% of CMV-seropositive HCT recipients. CMV reactivation leads to adverse outcomes including end-organ damage, graft-versus-host disease, and graft failure. Methods: Ganciclovir was administered pretransplant at 5 mg/kg twice daily intravenously from the start of conditioning to Day T-2 to CMV-seropositive patients receiving their first allogeneic HCT. CMV DNA was monitored weekly until at least Day 100 posttransplant. Results: A total of 109 consecutive patients were treated, median age 57 (range 20–73) years. Of these, 36 (33%) patients had a CMV reactivation within the first 105 days posttransplant with a median time of reactivation of 52.5 (range 36–104) days posttransplant.The cumulative
incidence of CMV reactivation at Day 105 posttransplant was 33.1% (95% confidence interval: 24.4–42.0). One patient developed CMV disease. Conclusion: The use of pretransplant ganciclovir was associated with low incidence of CMV reactivation and disease. These data suggest that pretransplant ganciclovir with preemptive therapy for viral reactivation may be a useful strategy to reduce CMV reactivation. Future prospective trials are needed to compare strategies for CMV prophylaxis.
Reed, Daniel R.; Petroni, Gina R.; West, Melissa; Jones, Caroline; Alfaraj, Abeer; Williams, Paige G.; DeGregory, Kathlene; Grose, Kyle; Monson, Sandra; Varadarajan, Indumathy; Volodin, Leonid; Donowitz, Gerald R.; Kindwall-Keller, Tamila L.; and Ballen, Karen K.
"Prophylactic pretransplant ganciclovir to reduce cytomegalovirus infection after hematopoietic stem cell transplantation,"
Hematology/Oncology and Stem Cell Therapy: Vol. 16
, Article 6.
Available at: https://doi.org/10.1016/j.hemonc.2021.05.001
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