Acyclovir for Prevention of Cytomegalovirus Infection and Disease after Allogeneic Marrow Transplantation
| Autor: | John H. Kersey, Joel D. Meyers, Paula S. Dandliker, David H. Shepp, E. Donnall Thomas, Elizabeth C. Reed, Catherine A. Vicary, L. E. Kirk, Nancy Flournoy, Henry H. Balfour, Mark D. Thornquist |
|---|---|
| Rok vydání: | 1988 |
| Předmět: |
Adult
Male Adolescent Pulmonary Fibrosis medicine.medical_treatment Congenital cytomegalovirus infection Acyclovir Cytomegalovirus Graft vs Host Disease Antibodies Viral medicine.disease_cause Herpesviridae Postoperative Complications Risk Factors Betaherpesvirinae Humans Medicine Aciclovir Child Bone Marrow Transplantation Analysis of Variance Leukemia biology business.industry virus diseases Herpes Simplex Immunosuppression General Medicine Middle Aged biology.organism_classification medicine.disease Transplantation medicine.anatomical_structure Child Preschool Cytomegalovirus Infections Injections Intravenous Immunology Drug Evaluation Female Viral disease Bone marrow business medicine.drug |
| Zdroj: | New England Journal of Medicine. 318:70-75 |
| ISSN: | 1533-4406 0028-4793 |
| DOI: | 10.1056/nejm198801143180202 |
| Popis: | Patients undergoing allogeneic bone marrow transplantation who are seropositive for cytomegalovirus are vulnerable to serious cytomegalovirus infection, presumably because of reactivation of latent endogenous virus and severe immunosuppression. We administered intravenous acyclovir from 5 days before to 30 days after allogeneic marrow transplantation for hematologic neoplasms in an effort to prevent cytomegalovirus infection and disease in patients seropositive for cytomegalovirus before transplantation. Eighty-six patients seropositive for both cytomegalovirus and herpes simplex virus before transplantation received acyclovir, whereas 65 patients seropositive only for cytomegalovirus served as controls (acyclovir is the standard prophylactic agent against herpes simplex virus in this setting). The probability that cytomegalovirus infection would develop within the first 100 days after transplantation was 0.70 among acyclovir recipients and 0.87 among control patients at medians of 62 and 40 days after transplantation, respectively (P = 0.0001 by log-rank test). Invasive cytomegalovirus disease developed in 19 acyclovir recipients (22 percent) and 25 control patients (38 percent) (P = 0.008). Survival within the first 100 days after transplantation was better among acyclovir recipients (P = 0.002). Acyclovir prophylaxis was associated with a relative risk of 0.5 or less for the development of cytomegalovirus infection or disease or for death within the first 100 days after transplantation (P less than or equal to 0.04), in proportional-hazards regression analysis. We conclude that prophylaxis with intravenous acyclovir significantly reduced the risk of both cytomegalovirus infection and cytomegalovirus disease in seropositive patients after allogeneic bone marrow transplantation and that it was also associated with significantly improved survival. |
| Databáze: | OpenAIRE |
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