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Extended routine polymerase chain reaction surveillance and pre-emptive antiviral therapy for cytomegalovirus after allogeneic transplantation.
Br J Haematol. 2000 Dec; 111(3):782-90.BJ

Abstract

Pre-emptive treatment strategies based on sensitive screening for cytomegalovirus (CMV) infection up to day +100 after allogeneic transplantation have been shown to reduce the incidence of CMV disease during the period of surveillance. However, the use of ganciclovir has been associated with delays in immune reconstitution and an increased incidence of late CMV disease after day +100. In the present study, 81 patients undergoing allogeneic transplantation received polymerase chain reaction (PCR)-guided pre-emptive therapy based on detection of CMV DNA by PCR on 2 consecutive weeks up to day +180. Thirty-three of the 52 high-risk patients (CMV-seropositive donor or recipient) received a total of 45 treatment episodes up to day +100. Three of these patients (5.7%) developed CMV disease, with one fatality. Twelve of the surviving 44 high-risk patients (27%) required pre-emptive treatment between days +101 and +192, but none of these patients developed late CMV disease with a median follow-up of 402 d (range 117-952 d). Antiviral therapy was stopped after a single negative PCR result with no subsequent episodes of CMV disease while patients remained off antiviral treatment. As all initial episodes of CMV DNA detection occurred within 60 d of transplantation, it may be possible to discontinue monitoring beyond day +100 in patients who have remained CMV PCR negative before this. Thus, we have confirmed that PCR-guided pre-emptive therapy results in a low incidence of CMV disease before day +100 and that discontinuing treatment on the basis of viral clearance as determined by CMV PCR appears to be safe practice. In addition, we have observed no episodes of late CMV disease with an extension of surveillance to 26 weeks.

Authors+Show Affiliations

Department of Haematology, University College London, London, UK.No 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

11122138

Citation

Peggs, K S., et al. "Extended Routine Polymerase Chain Reaction Surveillance and Pre-emptive Antiviral Therapy for Cytomegalovirus After Allogeneic Transplantation." British Journal of Haematology, vol. 111, no. 3, 2000, pp. 782-90.
Peggs KS, Preiser W, Kottaridis PD, et al. Extended routine polymerase chain reaction surveillance and pre-emptive antiviral therapy for cytomegalovirus after allogeneic transplantation. Br J Haematol. 2000;111(3):782-90.
Peggs, K. S., Preiser, W., Kottaridis, P. D., McKeag, N., Brink, N. S., Tedder, R. S., Goldstone, A. H., Linch, D. C., & Mackinnon, S. (2000). Extended routine polymerase chain reaction surveillance and pre-emptive antiviral therapy for cytomegalovirus after allogeneic transplantation. British Journal of Haematology, 111(3), 782-90.
Peggs KS, et al. Extended Routine Polymerase Chain Reaction Surveillance and Pre-emptive Antiviral Therapy for Cytomegalovirus After Allogeneic Transplantation. Br J Haematol. 2000;111(3):782-90. PubMed PMID: 11122138.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extended routine polymerase chain reaction surveillance and pre-emptive antiviral therapy for cytomegalovirus after allogeneic transplantation. AU - Peggs,K S, AU - Preiser,W, AU - Kottaridis,P D, AU - McKeag,N, AU - Brink,N S, AU - Tedder,R S, AU - Goldstone,A H, AU - Linch,D C, AU - Mackinnon,S, PY - 2000/12/21/pubmed PY - 2001/3/3/medline PY - 2000/12/21/entrez SP - 782 EP - 90 JF - British journal of haematology JO - Br J Haematol VL - 111 IS - 3 N2 - Pre-emptive treatment strategies based on sensitive screening for cytomegalovirus (CMV) infection up to day +100 after allogeneic transplantation have been shown to reduce the incidence of CMV disease during the period of surveillance. However, the use of ganciclovir has been associated with delays in immune reconstitution and an increased incidence of late CMV disease after day +100. In the present study, 81 patients undergoing allogeneic transplantation received polymerase chain reaction (PCR)-guided pre-emptive therapy based on detection of CMV DNA by PCR on 2 consecutive weeks up to day +180. Thirty-three of the 52 high-risk patients (CMV-seropositive donor or recipient) received a total of 45 treatment episodes up to day +100. Three of these patients (5.7%) developed CMV disease, with one fatality. Twelve of the surviving 44 high-risk patients (27%) required pre-emptive treatment between days +101 and +192, but none of these patients developed late CMV disease with a median follow-up of 402 d (range 117-952 d). Antiviral therapy was stopped after a single negative PCR result with no subsequent episodes of CMV disease while patients remained off antiviral treatment. As all initial episodes of CMV DNA detection occurred within 60 d of transplantation, it may be possible to discontinue monitoring beyond day +100 in patients who have remained CMV PCR negative before this. Thus, we have confirmed that PCR-guided pre-emptive therapy results in a low incidence of CMV disease before day +100 and that discontinuing treatment on the basis of viral clearance as determined by CMV PCR appears to be safe practice. In addition, we have observed no episodes of late CMV disease with an extension of surveillance to 26 weeks. SN - 0007-1048 UR - https://www.unboundmedicine.com/medline/citation/11122138/Extended_routine_polymerase_chain_reaction_surveillance_and_pre_emptive_antiviral_therapy_for_cytomegalovirus_after_allogeneic_transplantation_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0007-1048&date=2000&volume=111&issue=3&spage=782 DB - PRIME DP - Unbound Medicine ER -