Once daily ganciclovir as initial pre-emptive therapy delayed until threshold CMV load ⩾10000 copies/ml: a safe and effective strategy for allogeneic stem cell transplant patients
| Autor: | S M Devine, Ravi Vij, Linda A. Verkruyse, Gregory A. Storch, John F. DiPersio |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Ganciclovir medicine.medical_specialty Cytomegalovirus Viremia Antiviral Agents Polymerase Chain Reaction Gastroenterology Betaherpesvirinae Internal medicine medicine Humans Transplantation Homologous Aged Bone Marrow Transplantation Peripheral Blood Stem Cell Transplantation Transplantation Hematology biology business.industry virus diseases Middle Aged Viral Load medicine.disease biology.organism_classification Surgery Graft-versus-host disease Hematologic Neoplasms Cytomegalovirus Infections DNA Viral Female Viral disease business Viral load medicine.drug |
| Zdroj: | Bone Marrow Transplantation. 37:51-56 |
| ISSN: | 1476-5365 0268-3369 |
| DOI: | 10.1038/sj.bmt.1705213 |
| Popis: | Quantitative polymerase chain reaction (QPCR) for cytomegalovirus (CMV) is emerging as the preferred screening method for detection of CMV viremia in patients following allogeneic bone marrow and peripheral blood stem cell transplant. However, there are currently no universally accepted QPCR treatment thresholds at which to start pre-emptive therapy. We report here results of a pre-emptive therapy strategy using ganciclovir (GCV) 5 mg/kg initiated once daily (ODG) delayed till a threshold CMV load of > or =10 000 copies/ml whole blood in clinically stable patients. Sixty-nine at risk patients underwent allogeneic stem cell transplant. 48/69 (70%) patients had an initial episode of CMV viremia. 5/48 (10%) cleared viremia without requiring treatment. 28/43 (65%) patients requiring treatment initiated treatment with ODG. 17/28 (61%) patients successfully cleared CMV viremia on ODG, 10/28 (36%) patients required dose escalation to twice daily GCV for increasing viral loads. There were two cases of CMV disease (colitis) and no deaths due to CMV disease in patients initiating treatment with ODG. We conclude delaying pre-emptive therapy with ODG until whole blood QPCR> or =10 000 copies/ml is a safe and effective strategy for CMV viremia after allogeneic stem cell transplant in clinically stable patients. |
| Databáze: | OpenAIRE |
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