Cytomegalovirus pp65 antigenemia-guided early treatment with ganciclovir versus ganciclovir at engraftment after allogeneic marrow transplantation: a randomized double-blind study
| Autor: | David Myerson, Michael Boeckh, Gary Schoch, Terri Cunningham, Raleigh A. Bowden, Ted Gooley |
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| Předmět: |
Male
Transplantation Conditioning Antimetabolites viruses medicine.medical_treatment Cytomegalovirus Biochemistry Gastroenterology Polymerase Chain Reaction Child Antigens Viral Bone Marrow Transplantation First episode biology virus diseases Anemia Aplastic Immunosuppression Hematology Bacterial Infections Middle Aged surgical procedures operative Treatment Outcome Child Preschool Hematologic Neoplasms Cytomegalovirus Infections Female medicine.drug Ganciclovir Adult medicine.medical_specialty Neutropenia Adolescent Immunology Antiviral Agents Sensitivity and Specificity Viral Matrix Proteins stomatognathic system Double-Blind Method Betaherpesvirinae Internal medicine medicine Humans Viremia Aged Immunosuppression Therapy Chemotherapy business.industry Infant Cell Biology biochemical phenomena metabolism and nutrition medicine.disease biology.organism_classification Phosphoproteins Surgery Transplantation Mycoses business |
| Zdroj: | Europe PubMed Central |
| Popis: | To determine whether cytomegalovirus (CMV) antigenemiaguided ganciclovir treatment may be as effective, may require less treatment, and thus may cause less marrow toxicity than ganciclovir administered at engraftment, 226 marrow transplant recipients were randomized at engraftment to receive placebo (antigenemia-ganciclovir group) or ganciclovir (ganciclovir group) until day 100 in a double-blind study. In patients with antigenemia of 3 or more positive cells in 2 slides and/or viremia, study drug was discontinued and ganciclovir was started for at least 3 weeks or until negative CMV antigenemia and resumed only if antigenemia recurred. More patients in the antigenemia-ganciclovir group developed CMV disease before day 100 after transplantation compared with the ganciclovir group (14% v 2.7%, P = .002). Of the 16 patients with CMV disease before day 100 in the antigenemia-ganciclovir group, 10 (8.8%) had disease before or during the first episode of antigenemia and 6 (5.3%) developed disease after discontinuation of ganciclovir. Untreated low-grade antigenemia progressed to CMV disease in 19% of patients with grade 3–4 compared with 0% of patients with grade 0–2 acute graft-versus-host disease (P = .04). There was no significant difference in CMV disease by day 180 after transplantation and thereafter. CMV-related death, transplant survival, and neutropenia were not significantly different between the groups. In the ganciclovir group, more invasive fungal infections occurred (P = .03) and more ganciclovir was used (P |
| Databáze: | OpenAIRE |
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