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Pre-emptive therapy against cytomegalovirus (CMV) disease guided by CMV antigenemia assay after allogeneic hematopoietic stem cell transplantation: a single-center experience in Japan.
Bone Marrow Transplant. 2001 Feb; 27(4):437-44.BM

Abstract

From April 1998 to March 2000, a cytomegalovirus (CMV) antigenemia-guided pre-emptive approach for CMV disease was evaluated in 77 adult patients who received allogeneic hematopoietic stem cell transplantation at the National Cancer Center Hospital. A CMV antigenemia assay was performed at least once a week after engraftment. High-level antigenemia was defined as a positive result with 10 or more positive cells per 50 000 cells and low-level antigenemia was defined as less than 10 positive cells. Among the 74 patients with initial engraftment, 51 developed positive antigenemia. Transplantation from alternative donors and the development of grade II-IV GVHD were independent risk factors for positive antigenemia. Ganciclovir was administered as pre-emptive therapy in 39 patients in a risk-adapted manner. None of the nine low-risk patients with low-level antigenemia as their initial positive result developed high-level antigenemia even though ganciclovir was withheld. Only one patient developed early CMV disease (hepatitis) during the study period. CMV antigenemia resolved in all but two cases, in whom ganciclovir was replaced with foscarnet. In eight patients, however, the neutrophil count decreased to 0.5 x 10(9)/l or less after starting ganciclovir, including three with documented infections and two with subsequent secondary graft failure. The total amount of ganciclovir and possibly the duration of high-dose ganciclovir might affect the incidence of neutropenia. We concluded that antigenemia-guided pre-emptive therapy with a decreased dose of ganciclovir and response-oriented dose adjustment might be appropriate to decrease the toxicity of ganciclovir without increasing the risk of CMV disease.

Authors+Show Affiliations

Stem Cell Transplant Unit, National Cancer Center Hospital, 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 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 availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

11313674

Citation

Kanda, Y, et al. "Pre-emptive Therapy Against Cytomegalovirus (CMV) Disease Guided By CMV Antigenemia Assay After Allogeneic Hematopoietic Stem Cell Transplantation: a Single-center Experience in Japan." Bone Marrow Transplantation, vol. 27, no. 4, 2001, pp. 437-44.
Kanda Y, Mineishi S, Saito T, et al. Pre-emptive therapy against cytomegalovirus (CMV) disease guided by CMV antigenemia assay after allogeneic hematopoietic stem cell transplantation: a single-center experience in Japan. Bone Marrow Transplant. 2001;27(4):437-44.
Kanda, Y., Mineishi, S., Saito, T., Seo, S., Saito, A., Suenaga, K., Ohnishi, M., Niiya, H., Nakai, K., Takeuchi, T., Kawahigashi, N., Shoji, N., Ogasawara, T., Tanosaki, R., Kobayashi, Y., Tobinai, K., Kami, M., Mori, S., Suzuki, R., ... Takaue, Y. (2001). Pre-emptive therapy against cytomegalovirus (CMV) disease guided by CMV antigenemia assay after allogeneic hematopoietic stem cell transplantation: a single-center experience in Japan. Bone Marrow Transplantation, 27(4), 437-44.
Kanda Y, et al. Pre-emptive Therapy Against Cytomegalovirus (CMV) Disease Guided By CMV Antigenemia Assay After Allogeneic Hematopoietic Stem Cell Transplantation: a Single-center Experience in Japan. Bone Marrow Transplant. 2001;27(4):437-44. PubMed PMID: 11313674.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pre-emptive therapy against cytomegalovirus (CMV) disease guided by CMV antigenemia assay after allogeneic hematopoietic stem cell transplantation: a single-center experience in Japan. AU - Kanda,Y, AU - Mineishi,S, AU - Saito,T, AU - Seo,S, AU - Saito,A, AU - Suenaga,K, AU - Ohnishi,M, AU - Niiya,H, AU - Nakai,K, AU - Takeuchi,T, AU - Kawahigashi,N, AU - Shoji,N, AU - Ogasawara,T, AU - Tanosaki,R, AU - Kobayashi,Y, AU - Tobinai,K, AU - Kami,M, AU - Mori,S, AU - Suzuki,R, AU - Kunitoh,H, AU - Takaue,Y, PY - 2000/07/27/received PY - 2000/11/02/accepted PY - 2001/4/21/pubmed PY - 2001/8/10/medline PY - 2001/4/21/entrez SP - 437 EP - 44 JF - Bone marrow transplantation JO - Bone Marrow Transplant VL - 27 IS - 4 N2 - From April 1998 to March 2000, a cytomegalovirus (CMV) antigenemia-guided pre-emptive approach for CMV disease was evaluated in 77 adult patients who received allogeneic hematopoietic stem cell transplantation at the National Cancer Center Hospital. A CMV antigenemia assay was performed at least once a week after engraftment. High-level antigenemia was defined as a positive result with 10 or more positive cells per 50 000 cells and low-level antigenemia was defined as less than 10 positive cells. Among the 74 patients with initial engraftment, 51 developed positive antigenemia. Transplantation from alternative donors and the development of grade II-IV GVHD were independent risk factors for positive antigenemia. Ganciclovir was administered as pre-emptive therapy in 39 patients in a risk-adapted manner. None of the nine low-risk patients with low-level antigenemia as their initial positive result developed high-level antigenemia even though ganciclovir was withheld. Only one patient developed early CMV disease (hepatitis) during the study period. CMV antigenemia resolved in all but two cases, in whom ganciclovir was replaced with foscarnet. In eight patients, however, the neutrophil count decreased to 0.5 x 10(9)/l or less after starting ganciclovir, including three with documented infections and two with subsequent secondary graft failure. The total amount of ganciclovir and possibly the duration of high-dose ganciclovir might affect the incidence of neutropenia. We concluded that antigenemia-guided pre-emptive therapy with a decreased dose of ganciclovir and response-oriented dose adjustment might be appropriate to decrease the toxicity of ganciclovir without increasing the risk of CMV disease. SN - 0268-3369 UR - https://www.unboundmedicine.com/medline/citation/11313674/Pre_emptive_therapy_against_cytomegalovirus__CMV__disease_guided_by_CMV_antigenemia_assay_after_allogeneic_hematopoietic_stem_cell_transplantation:_a_single_center_experience_in_Japan_ L2 - https://doi.org/10.1038/sj.bmt.1702805 DB - PRIME DP - Unbound Medicine ER -