Prophylactic Pretransplant Ganciclovir to Reduce Cytomegalovirus Infection After Hematopoietic Stem Cell Transplantation.

Q1 Medicine

Hematology/ Oncology and Stem Cell Therapy Pub Date : 2023-01-12 DOI:10.1016/j.hemonc.2021.05.001

Daniel R Reed, Gina R Petroni, Melissa West, Caroline Jones, Abeer Alfaraj, Paige G Williams, Kathlene DeGregory, Kyle Grose, Sandra Monson, Indumathy Varadarajan, Leonid Volodin, Gerald R Donowitz, Tamila L Kindwall-Keller, Karen K Ballen

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引用次数: 2

Abstract

Objective/background: Cytomegalovirus (CMV) reactivation remains a serious complication after allogeneic hematopoietic cell transplantation (HCT) occurring in approximately 60-70% of CMV-seropositive HCT recipients. CMV reactivation leads to adverse outcomes including end-organ damage, graft-versus-host disease, and graft failure.

Methods: Ganciclovir was administered pretransplant at 5 mg/kg twice daily intravenously from the start of conditioning to Day T-2 to CMV-seropositive patients receiving their first allogeneic HCT. CMV DNA was monitored weekly until at least Day 100 posttransplant.

Results: A total of 109 consecutive patients were treated, median age 57 (range 20-73) years. Of these, 36 (33%) patients had a CMV reactivation within the first 105 days posttransplant with a median time of reactivation of 52.5 (range 36-104) days posttransplant. The cumulative incidence of CMV reactivation at Day 105 posttransplant was 33.1% (95% confidence interval: 24.4-42.0). One patient developed CMV disease.

Conclusion: The use of pretransplant ganciclovir was associated with low incidence of CMV reactivation and disease. These data suggest that pretransplant ganciclovir with preemptive therapy for viral reactivation may be a useful strategy to reduce CMV reactivation. Future prospective trials are needed to compare strategies for CMV prophylaxis.

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移植前预防性使用更昔洛韦减少造血干细胞移植后巨细胞病毒感染。

目的/背景:巨细胞病毒(CMV)再激活仍然是同种异体造血细胞移植(HCT)后的一个严重并发症，发生在大约60-70%的CMV血清阳性HCT受体中。巨细胞病毒再激活会导致不良后果，包括终末器官损伤、移植物抗宿主病和移植物衰竭。方法:对首次接受同种异体HCT的cmv血清阳性患者，从适应开始至第T-2天，移植前静脉注射更昔洛韦5 mg/kg，每日2次。每周监测巨细胞病毒DNA，直到移植后至少100天。结果:共有109例患者连续接受治疗，中位年龄57岁(范围20-73岁)。其中，36例(33%)患者在移植后105天内出现巨细胞病毒再激活，移植后中位再激活时间为52.5天(范围36-104天)。移植后第105天CMV再激活的累积发生率为33.1%(95%可信区间:24.4-42.0)。一名患者出现巨细胞病毒病。结论:移植前使用更昔洛韦与CMV再激活和疾病的低发生率相关。这些数据表明移植前更昔洛韦与病毒再激活的先发制人治疗可能是减少巨细胞病毒再激活的有效策略。未来的前瞻性试验需要比较CMV预防策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hematology/ Oncology and Stem Cell Therapy Medicine-Hematology

CiteScore

4.30

自引率

0.00%

发文量

审稿时长

27 weeks

期刊介绍： Hematology Oncology and Stem Cell Therapy is an international, peer-reviewed, open access journal that provides a vehicle for publications of high-quality clinical as well as basic science research reports in hematology and oncology. The contents of the journal also emphasize the growing importance of hematopoietic stem cell therapy for treatment of various benign and malignant hematologic disorders and certain solid tumors.The journal prioritizes publication of original research articles but also would give consideration for brief reports, review articles, special communications, and unique case reports. It also offers a special section for clinically relevant images that provide an important educational value.