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Risk-adapted pre-emptive therapy for cytomegalovirus disease in patients undergoing allogeneic bone marrow transplantation.
Bone Marrow Transplant. 2000 Apr; 25(7):765-9.BM

Abstract

We prospectively evaluated a risk-adapted pre-emptive treatment with ganciclovir for CMV diseases in patients undergoing allogeneic bone marrow transplantation (BMT). High-level CMV antigenemia (10 or more positive cells on two slides) or CMV antigenemia at any level in patients with grade II-IV acute graft-versus-host disease (aGVHD) were chosen as risk factors. We also retrospectively evaluated virus reactivation in plasma using quantitative real-time polymerase chain reaction (PCR). Fifty patients were evaluable. None of the 27 patients with or without grade I aGVHD developed high-level CMV antigenemia or CMV disease. Among the 23 patients with grade II-IV aGVHD, 12 patients (52%) developed CMV antigenemia and were treated pre-emptively, of whom two developed CMV gastroenteritis or retinitis in spite of therapy. Six of the remaining 11 patients developed CMV gastroenteritis before CMV antigenemia was detectable. All of the eight patients with CMV diseases were successfully treated with ganciclovir and no deaths directly related to CMV disease occurred. In four of the seven evaluable patients with CMV gastroenteritis, real-time PCR was able to detect virus reactivation earlier than CMV antigenemia. Although our risk-adapted pre-emptive therapy effectively reduced CMV-related mortality, further refinements of this approach, particularly in the prevention of CMV gastroenteritis, may be achieved by incorporating real-time PCR.

Authors+Show Affiliations

Division of Hematology, Keio University School of Medicine, Tokyo, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10745263

Citation

Mori, T, et al. "Risk-adapted Pre-emptive Therapy for Cytomegalovirus Disease in Patients Undergoing Allogeneic Bone Marrow Transplantation." Bone Marrow Transplantation, vol. 25, no. 7, 2000, pp. 765-9.
Mori T, Okamoto S, Matsuoka S, et al. Risk-adapted pre-emptive therapy for cytomegalovirus disease in patients undergoing allogeneic bone marrow transplantation. Bone Marrow Transplant. 2000;25(7):765-9.
Mori, T., Okamoto, S., Matsuoka, S., Yajima, T., Wakui, M., Watanabe, R., Ishida, A., Iwao, Y., Mukai, M., Hibi, T., & Ikeda, Y. (2000). Risk-adapted pre-emptive therapy for cytomegalovirus disease in patients undergoing allogeneic bone marrow transplantation. Bone Marrow Transplantation, 25(7), 765-9.
Mori T, et al. Risk-adapted Pre-emptive Therapy for Cytomegalovirus Disease in Patients Undergoing Allogeneic Bone Marrow Transplantation. Bone Marrow Transplant. 2000;25(7):765-9. PubMed PMID: 10745263.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk-adapted pre-emptive therapy for cytomegalovirus disease in patients undergoing allogeneic bone marrow transplantation. AU - Mori,T, AU - Okamoto,S, AU - Matsuoka,S, AU - Yajima,T, AU - Wakui,M, AU - Watanabe,R, AU - Ishida,A, AU - Iwao,Y, AU - Mukai,M, AU - Hibi,T, AU - Ikeda,Y, PY - 2000/4/4/pubmed PY - 2000/5/20/medline PY - 2000/4/4/entrez SP - 765 EP - 9 JF - Bone marrow transplantation JO - Bone Marrow Transplant VL - 25 IS - 7 N2 - We prospectively evaluated a risk-adapted pre-emptive treatment with ganciclovir for CMV diseases in patients undergoing allogeneic bone marrow transplantation (BMT). High-level CMV antigenemia (10 or more positive cells on two slides) or CMV antigenemia at any level in patients with grade II-IV acute graft-versus-host disease (aGVHD) were chosen as risk factors. We also retrospectively evaluated virus reactivation in plasma using quantitative real-time polymerase chain reaction (PCR). Fifty patients were evaluable. None of the 27 patients with or without grade I aGVHD developed high-level CMV antigenemia or CMV disease. Among the 23 patients with grade II-IV aGVHD, 12 patients (52%) developed CMV antigenemia and were treated pre-emptively, of whom two developed CMV gastroenteritis or retinitis in spite of therapy. Six of the remaining 11 patients developed CMV gastroenteritis before CMV antigenemia was detectable. All of the eight patients with CMV diseases were successfully treated with ganciclovir and no deaths directly related to CMV disease occurred. In four of the seven evaluable patients with CMV gastroenteritis, real-time PCR was able to detect virus reactivation earlier than CMV antigenemia. Although our risk-adapted pre-emptive therapy effectively reduced CMV-related mortality, further refinements of this approach, particularly in the prevention of CMV gastroenteritis, may be achieved by incorporating real-time PCR. SN - 0268-3369 UR - https://www.unboundmedicine.com/medline/citation/10745263/Risk_adapted_pre_emptive_therapy_for_cytomegalovirus_disease_in_patients_undergoing_allogeneic_bone_marrow_transplantation_ L2 - https://doi.org/10.1038/sj.bmt.1702227 DB - PRIME DP - Unbound Medicine ER -