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A randomised trial comparing cytomegalovirus antigenemia assay vs screening bronchoscopy for the early detection and prevention of disease in allogeneic bone marrow and peripheral blood stem cell transplant recipients.
Bone Marrow Transplant. 2001 Sep; 28(5):485-90.BM

Abstract

Preemptive antiviral therapy is often employed for CMV prevention following allogeneic BMT. Two common strategies are a screening bronchoscopy for CMV post-BMT or regular CMV antigenemia testing with ganciclovir administration for a positive result. In a randomised trial, we prospectively compared the efficacy of these two preemptive strategies. Consecutive patients were randomised to either a bronchoscopy for CMV on day 35 post BMT or weekly CMV antigenemia testing. If the bronchoscopy was positive for CMV, patients received preemptive ganciclovir for 8-10 weeks. If the antigenemia was positive for CMV, patients received a minimum of 2 weeks of preemptive ganciclovir. The primary endpoint was the development of active CMV disease. One hundred and eighteen allogeneic BMT patients were enrolled (60 in the antigenemia arm and 58 in the bronchoscopy arm). The two groups were comparable with respect to baseline demographic data, underlying disease, conditioning regimen, and immunosuppression. Active CMV disease developed in 7/58 (12.1%) patients in the bronchoscopy arm vs 1/60 patients (1.7%) in the CMV antigenemia arm (P = 0.022). Based on the screening test, 13.8% of patients received preemptive ganciclovir in the bronchoscopy arm vs 48.3% of patients in the antigenemia arm (P < 0.001). There was no significant difference in the rate of graft-versus-host disease, bacteremia, invasive fungal infections or mortality between the two groups. Preemptive therapy based on regular CMV antigenemia monitoring is superior to screening bronchoscopy for the prevention of CMV disease after allogeneic BMT.

Authors+Show Affiliations

Department of Medicine, Division of Infectious Diseases, Toronto General Hospital-University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11593322

Citation

Humar, A, et al. "A Randomised Trial Comparing Cytomegalovirus Antigenemia Assay Vs Screening Bronchoscopy for the Early Detection and Prevention of Disease in Allogeneic Bone Marrow and Peripheral Blood Stem Cell Transplant Recipients." Bone Marrow Transplantation, vol. 28, no. 5, 2001, pp. 485-90.
Humar A, Lipton J, Welsh S, et al. A randomised trial comparing cytomegalovirus antigenemia assay vs screening bronchoscopy for the early detection and prevention of disease in allogeneic bone marrow and peripheral blood stem cell transplant recipients. Bone Marrow Transplant. 2001;28(5):485-90.
Humar, A., Lipton, J., Welsh, S., Moussa, G., Messner, H., & Mazzulli, T. (2001). A randomised trial comparing cytomegalovirus antigenemia assay vs screening bronchoscopy for the early detection and prevention of disease in allogeneic bone marrow and peripheral blood stem cell transplant recipients. Bone Marrow Transplantation, 28(5), 485-90.
Humar A, et al. A Randomised Trial Comparing Cytomegalovirus Antigenemia Assay Vs Screening Bronchoscopy for the Early Detection and Prevention of Disease in Allogeneic Bone Marrow and Peripheral Blood Stem Cell Transplant Recipients. Bone Marrow Transplant. 2001;28(5):485-90. PubMed PMID: 11593322.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomised trial comparing cytomegalovirus antigenemia assay vs screening bronchoscopy for the early detection and prevention of disease in allogeneic bone marrow and peripheral blood stem cell transplant recipients. AU - Humar,A, AU - Lipton,J, AU - Welsh,S, AU - Moussa,G, AU - Messner,H, AU - Mazzulli,T, PY - 2001/01/26/received PY - 2001/05/25/accepted PY - 2001/10/11/pubmed PY - 2002/1/5/medline PY - 2001/10/11/entrez SP - 485 EP - 90 JF - Bone marrow transplantation JO - Bone Marrow Transplant VL - 28 IS - 5 N2 - Preemptive antiviral therapy is often employed for CMV prevention following allogeneic BMT. Two common strategies are a screening bronchoscopy for CMV post-BMT or regular CMV antigenemia testing with ganciclovir administration for a positive result. In a randomised trial, we prospectively compared the efficacy of these two preemptive strategies. Consecutive patients were randomised to either a bronchoscopy for CMV on day 35 post BMT or weekly CMV antigenemia testing. If the bronchoscopy was positive for CMV, patients received preemptive ganciclovir for 8-10 weeks. If the antigenemia was positive for CMV, patients received a minimum of 2 weeks of preemptive ganciclovir. The primary endpoint was the development of active CMV disease. One hundred and eighteen allogeneic BMT patients were enrolled (60 in the antigenemia arm and 58 in the bronchoscopy arm). The two groups were comparable with respect to baseline demographic data, underlying disease, conditioning regimen, and immunosuppression. Active CMV disease developed in 7/58 (12.1%) patients in the bronchoscopy arm vs 1/60 patients (1.7%) in the CMV antigenemia arm (P = 0.022). Based on the screening test, 13.8% of patients received preemptive ganciclovir in the bronchoscopy arm vs 48.3% of patients in the antigenemia arm (P < 0.001). There was no significant difference in the rate of graft-versus-host disease, bacteremia, invasive fungal infections or mortality between the two groups. Preemptive therapy based on regular CMV antigenemia monitoring is superior to screening bronchoscopy for the prevention of CMV disease after allogeneic BMT. SN - 0268-3369 UR - https://www.unboundmedicine.com/medline/citation/11593322/A_randomised_trial_comparing_cytomegalovirus_antigenemia_assay_vs_screening_bronchoscopy_for_the_early_detection_and_prevention_of_disease_in_allogeneic_bone_marrow_and_peripheral_blood_stem_cell_transplant_recipients_ L2 - https://doi.org/10.1038/sj.bmt.1703178 DB - PRIME DP - Unbound Medicine ER -