The Effect of Preemptive Therapy with Intravenous Ganciclovir Followed by Oral Ganciclovir against Cytomegalovirus Infection after Allogeneic Peripheral Blood Stem Cell Transplantation.
- Author:
Jong Gwang KIM
1
;
Woo Jin SUNG
;
Yi Soo CHE
;
Kwang Woon SEO
;
Sung Won PARK
;
Jin Tae JUNG
;
Sang Kyun SOHN
;
Kang Soo SUH
;
Kyu Bo LEE
Author Information
1. Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Korea. sksohn@kyungpook.ac.kr
- Publication Type:In Vitro ; Original Article
- Keywords:
Cytomegalovirus;
CMV antigenemia;
Allogeneic PBSCT;
Preemptive therapy
- MeSH:
Bone Marrow Transplantation;
Cytomegalovirus Infections*;
Cytomegalovirus*;
Ganciclovir*;
Humans;
Incidence;
Lung Diseases;
Mass Screening;
Mortality;
Peripheral Blood Stem Cell Transplantation*
- From:Korean Journal of Hematology
2002;37(1):31-37
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Recently, in vitro studies demonstrated faster immune reconstitution after allogeneic peripheral blood stem cell transplantation (PBSCT) compared to bone marrow transplantation (BMT). In consequence, it can be expected that better immune reconstitution against cytomegalovirus (CMV) will lead to a reduced CMV-related morbidity and mortality after allogeneic PBSCT. METHODS: Forty seven patients who received allogeneic PBSCT were enrolled. CMV was routinely sought by at least weekly screening for CMV-related matrix protein pp65 antigenemia after engraftment (WBC >1,500/nL) was achieved. CMV antigenemia was treated with ganciclovir 5mg/kg twice daily i.v. as preemptive therapy for at least 10 days. After then, ganciclovir i.v. was switched to oral ganciclovir for maintenance therapy. RESULTS: CMV antigenemia was detected 8 (17%) out of 47 patients and CMV disease developed in only 1 case (2.1%). The medianperiod of time until the detection of CMV antigenemia was 51.5 days (range, 35~230). In 7 out of 8 cases, CMV antigenemia disappeared with ganciclovir treatment in 7 days. One patient with CMV disease (CMV interstitial pneumonitis) showed persistent CMV antigenemia for 3 months and expired due to restrictive lung disease. CONCLUSION: The incidence of CMV antigenemia and resistance to ganciclovir treatment was lower than the incidence of those reported in allogeneic BMT trials. These findings suggest that faster immune reconstitution against CMV after allogeneic PBSCT might have a stronger role in the prevention of emergence of CMV antigenemia and ganciclovir treatment than after allogeneic BMT.
