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Annals of Hematology

, Volume 83, Issue 9, pp 573–577 | Cite as

Ganciclovir-related neutropenia after preemptive therapy for cytomegalovirus infection: comparison between cord blood and bone marrow transplantation

  • Akira Tomonari
  • Tohru Iseki
  • Satoshi Takahashi
  • Jun Ooi
  • Toshiki Yamada
  • Kashiya Takasugi
  • Fumitaka Nagamura
  • Kaoru Uchimaru
  • Arinobu Tojo
  • Shigetaka Asano
Original Article

Abstract

We studied ganciclovir (GCV)-related neutropenia after preemptive therapy for cytomegalovirus infection: 9 of 17 (53%) cord blood transplantation (CBT) patients and 18 of 20 (90%) bone marrow transplantation (BMT) patients developed GCV-related neutropenia with an absolute neutrophil count (ANC) of less than 1000/μl. Among the patients who did not receive granulocyte colony-stimulating factor, 2 (13%) and 1 (7%) CBT patients, and 10 (56%) and 8 (44%) BMT patients, developed neutropenia with an ANC of less than 500 and 250/μl, respectively. The incidences of neutropenia in patients with an ANC of less than 1000, 500, and 250/μl were significantly lower after CBT in comparison with BMT. Two BMT patients, but no CBT patients, developed neutropenic fever, and both patients recovered after antibiotic therapy. In CBT patients, a creatinine clearance rate of less than 50 ml/min and an absence of steroid therapy were associated with a greater incidence of GCV-related neutropenia. No risk factors for GCV-related neutropenia were found in BMT patients. These results suggest that GCV may be less toxic to myeloid progenitor cells from cord blood than those from bone marrow.

Keywords

Ganciclovir Neutropenia Cytomegalovirus Cord blood transplantation 

Notes

Acknowledgments

The authors thank Maki Monna-Oiwa for her secretarial assistance. We also thank the KOBAYASHI Foundation for financial support.

References

  1. 1.
    Forman SJ, Zaia JA (1994) Treatment and prevention of cytomegalovirus pneumonia after bone marrow transplantation: where do we stand? Blood 83:2392–2398PubMedGoogle Scholar
  2. 2.
    Goodrich JM, Bowden RA, Fisher L, Keller C, Schoch G, Meyers JD (1993) Ganciclovir prophylaxis to prevent cytomegalovirus disease after allogeneic marrow transplant. Ann Intern Med 118:173–178Google Scholar
  3. 3.
    Boeckh M, Bowden RA, Gooley T, Myerson D, Corey L (1999) Successful modification of a pp65 antigenemia-based early treatment strategy for prevention of cytomegalovirus disease in allogeneic marrow transplant recipients. Blood 93:1781–1782PubMedGoogle Scholar
  4. 4.
    Salzberger B, Bowden RA, Hackman RC, Davis C, Boeckh M (1997) Neutropenia in allogeneic marrow transplant recipients receiving ganciclovir for prevention of cytomegalovirus disease: risk factors and outcome. Blood 90:2502–2508PubMedGoogle Scholar
  5. 5.
    Tomonari A, Iseki T, Ooi J, Takahashi S, Shindo M, Ishii K, Nagamura F, Uchimaru K, Tani K, Tojo A, Asano S (2003) Cytomegalovirus infection following unrelated cord blood transplantation for adult patients: a single institute experience in Japan. Br J Haematol 121:304–311PubMedGoogle Scholar
  6. 6.
    Snydman DR (1988) Ganciclovir therapy for cytomegalovirus disease associated with renal transplants. Rev Infect Dis 10 [Suppl 3]:S554–S562PubMedGoogle Scholar
  7. 7.
    Sommadossi JP, Carlisle R (1987) Toxicity of 3′-azido-3′-deoxythymidine and 9-(1,3-dihydroxy-2-propoxymethyl)guanine for normal human hematopoietic progenitor cells in vitro. Antimicrob Agents Chemother 31:452–454PubMedGoogle Scholar
  8. 8.
    Crumpacker CS (1996) Ganciclovir. N Engl J Med 335:721–729PubMedGoogle Scholar
  9. 9.
    Holberg-Petersen M, Rollag H, Beck S, Overli I, Tjonnfjord G, Abrahamsen TG, Degre M, Hestdal K (1996) Direct growth suppression of myeloid bone marrow progenitor cells but not cord blood progenitors by human cytomegalovirus in vitro. Blood 88:2510–2516PubMedGoogle Scholar
  10. 10.
    Sommadossi JP, Bevan R, Ling T, Lee F, Mastre B, Chaplin MD, Nerenberg C, Koretz S, Buhles WC, Sommadossi JP, Bevan R, Ling T, Lee F, Mastre B, Chaplin MD, Nerenberg C, Koretz S, Buhles WC (1988) Clinical pharmacokinetics of ganciclovir in patients with normal and impaired renal function. Rev Infect Dis 10 [Suppl 3]:S507–S514PubMedGoogle Scholar
  11. 11.
    Saavedra S, Sanz GF, Jarque I, Moscardo F, Jimenez C, Lorenzo I, Martin G, Martinez J, De la Rubia J, Andreu R, Molla S, Llopis I, Fernandez MJ, Salavert M, Acosta B, Gobernado M, Sanz MA (2002) Early infections in adult patients undergoing unrelated donor cord blood transplantation. Bone Marrow Transplant 30:937–943CrossRefPubMedGoogle Scholar
  12. 12.
    Michel G, Rocha V, Chevret S, Arcese W, Chan KW, Filipovich A, Takahashi TA, Vowels M, Ortega J, Bordigoni P, Shaw PJ, Yaniv I, Machado A, Pimentel P, Fagioli F, Verdeguer A, Jouet JP, Diez B, Ferreira E, Pasquini R, Rosenthal J, Sievers E, Messina C, Iori AP, Garnier F, Ionescu I, Locatelli F, Gluckman E (2003) Unrelated cord blood transplantation for childhood acute myeloid leukemia: a Eurocord Group analysis. Blood 102:4290–4297CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Akira Tomonari
    • 1
  • Tohru Iseki
    • 1
  • Satoshi Takahashi
    • 1
  • Jun Ooi
    • 1
  • Toshiki Yamada
    • 1
  • Kashiya Takasugi
    • 1
  • Fumitaka Nagamura
    • 1
  • Kaoru Uchimaru
    • 1
  • Arinobu Tojo
    • 1
  • Shigetaka Asano
    • 1
  1. 1.Department of Hematology/Oncology, The Institute of Medical ScienceThe University of TokyoTokyoJapan

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