Prophylactic pretransplant ganciclovir to reduce cytomegalovirus infection after hematopoietic stem cell transplantation

Daniel R. Reed, Section of Hematology and Oncology, Comprehensive Cancer Center of Wake Forest Baptist Health, Winston-Salem, NC, USAFollow
Gina R. Petroni, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
Melissa West, Department of Pharmacy, University of Virginia, Charlottesville, VA, USA
Caroline Jones, Department of Pharmacy, University of Virginia, Charlottesville, VA, USA
Abeer Alfaraj, BayHealth Hematology/Oncology Associates, Delaware, PA, USA
Paige G. Williams, Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA
Kathlene DeGregory, Department of Pharmacy, University of Virginia, Charlottesville, VA, USA
Kyle Grose, Department of Pharmacy, University of Kansas, Kansas City, KS, USA
Sandra Monson, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
Indumathy Varadarajan, Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA
Leonid Volodin, Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA
Gerald R. Donowitz, Department of Infectious Disease, University of Virginia, Charlottesville, VA, USA
Tamila L. Kindwall-Keller, Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA
Karen K. Ballen, Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA

Abstract

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.

Recommended Citation

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. (2023) "Prophylactic pretransplant ganciclovir to reduce cytomegalovirus infection after hematopoietic stem cell transplantation," Hematology/Oncology and Stem Cell Therapy: Vol. 16 : Iss. 1 , Article 6.
Available at: https://doi.org/10.1016/j.hemonc.2021.05.001