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High-dose acyclovir and pre-emptive ganciclovir to prevent cytomegalovirus disease in myeloablative and non-myeloablative allogeneic stem cell transplantation.
Bone Marrow Transplant. 2002 Aug; 30(4):235-42.BM

Abstract

We evaluated high-dose acyclovir and pre-emptive ganciclovir to prevent cytomegalovirus disease in myeloablative and non-myeloablative allogeneic stem cell transplantation. One hundred and seventy-four consecutive patients who were at risk for CMV infection (either recipient or donor seropositive) and received either intensive chemoradiotherapy and a T cell-depleted stem cell transplant followed by delayed add-back of donor T cells (TCDT: n = 98), or a non-myeloablative preparative regimen followed by an unmanipulated peripheral blood stem cell transplant (NMT: n = 76) from an HLA-identical sibling donor were studied. All received high-dose acyclovir (HDACV) from day - 7 for 3 months post-transplant in conjunction with weekly CMV pp65 antigenemia monitoring and pre-emptive treatment with intravenous immunoglobulin (not CMV-specific) and ganciclovir. The actuarial probabilities of developing pp65 antigenemia were 83 +/- 4% after TCDT and 41 +/- 6% after NMT (P < 0.00001) with reactivation occurring earlier in the TCDT group (the median 36 days vs 55 days). We observed no reactivation of CMV in seronegative recipients with a seropositive donor (n = 23). A total of 11 patients (5 in TCDT, 6 in NMT) developed CMV disease within 400 days after transplantation, and one death was clearly attributable to CMV interstitial pneumonitis (IP). This strategy was associated with effective control of CMV antigenemia in the majority of patients and near-complete eradication of fatal CMV IP.

Authors+Show Affiliations

Stem Cell Allogeneic Transplant Unit, Hematology Branch, National Heart, Lung, and Blood Institute, National Institute of Health, Bethesda, MD 20892, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

12203140

Citation

Nakamura, R, et al. "High-dose Acyclovir and Pre-emptive Ganciclovir to Prevent Cytomegalovirus Disease in Myeloablative and Non-myeloablative Allogeneic Stem Cell Transplantation." Bone Marrow Transplantation, vol. 30, no. 4, 2002, pp. 235-42.
Nakamura R, Cortez K, Solomon S, et al. High-dose acyclovir and pre-emptive ganciclovir to prevent cytomegalovirus disease in myeloablative and non-myeloablative allogeneic stem cell transplantation. Bone Marrow Transplant. 2002;30(4):235-42.
Nakamura, R., Cortez, K., Solomon, S., Battiwalla, M., Gill, V. J., Hensel, N., Childs, R., & Barrett, A. J. (2002). High-dose acyclovir and pre-emptive ganciclovir to prevent cytomegalovirus disease in myeloablative and non-myeloablative allogeneic stem cell transplantation. Bone Marrow Transplantation, 30(4), 235-42.
Nakamura R, et al. High-dose Acyclovir and Pre-emptive Ganciclovir to Prevent Cytomegalovirus Disease in Myeloablative and Non-myeloablative Allogeneic Stem Cell Transplantation. Bone Marrow Transplant. 2002;30(4):235-42. PubMed PMID: 12203140.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-dose acyclovir and pre-emptive ganciclovir to prevent cytomegalovirus disease in myeloablative and non-myeloablative allogeneic stem cell transplantation. AU - Nakamura,R, AU - Cortez,K, AU - Solomon,S, AU - Battiwalla,M, AU - Gill,V J, AU - Hensel,N, AU - Childs,R, AU - Barrett,A J, PY - 2002/03/08/received PY - 2002/04/29/accepted PY - 2002/8/31/pubmed PY - 2003/7/29/medline PY - 2002/8/31/entrez SP - 235 EP - 42 JF - Bone marrow transplantation JO - Bone Marrow Transplant VL - 30 IS - 4 N2 - We evaluated high-dose acyclovir and pre-emptive ganciclovir to prevent cytomegalovirus disease in myeloablative and non-myeloablative allogeneic stem cell transplantation. One hundred and seventy-four consecutive patients who were at risk for CMV infection (either recipient or donor seropositive) and received either intensive chemoradiotherapy and a T cell-depleted stem cell transplant followed by delayed add-back of donor T cells (TCDT: n = 98), or a non-myeloablative preparative regimen followed by an unmanipulated peripheral blood stem cell transplant (NMT: n = 76) from an HLA-identical sibling donor were studied. All received high-dose acyclovir (HDACV) from day - 7 for 3 months post-transplant in conjunction with weekly CMV pp65 antigenemia monitoring and pre-emptive treatment with intravenous immunoglobulin (not CMV-specific) and ganciclovir. The actuarial probabilities of developing pp65 antigenemia were 83 +/- 4% after TCDT and 41 +/- 6% after NMT (P < 0.00001) with reactivation occurring earlier in the TCDT group (the median 36 days vs 55 days). We observed no reactivation of CMV in seronegative recipients with a seropositive donor (n = 23). A total of 11 patients (5 in TCDT, 6 in NMT) developed CMV disease within 400 days after transplantation, and one death was clearly attributable to CMV interstitial pneumonitis (IP). This strategy was associated with effective control of CMV antigenemia in the majority of patients and near-complete eradication of fatal CMV IP. SN - 0268-3369 UR - https://www.unboundmedicine.com/medline/citation/12203140/High_dose_acyclovir_and_pre_emptive_ganciclovir_to_prevent_cytomegalovirus_disease_in_myeloablative_and_non_myeloablative_allogeneic_stem_cell_transplantation_ L2 - https://doi.org/10.1038/sj.bmt.1703648 DB - PRIME DP - Unbound Medicine ER -