International Journal of Hematology

, Volume 92, Issue 2, pp 351–359 | Cite as

Use of foscarnet for cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation from a related donor

  • Maiko Asakura
  • Kazuhiro Ikegame
  • Satoshi Yoshihara
  • Shuichi Taniguchi
  • Takehiko Mori
  • Tetsuya Etoh
  • Akiyoshi Takami
  • Takashi Yoshida
  • Takahiro Fukuda
  • Kazuo Hatanaka
  • Heiwa Kanamori
  • Toshiaki Yujiri
  • Yoshiko Atsuta
  • Hisashi Sakamaki
  • Ritsuro Suzuki
  • Hiroyasu Ogawa
Original Article

Abstract

Foscarnet is an active agent against cytomegalovirus (CMV) infection after hematopoietic stem cell transplantation (HSCT), as well as ganciclovir. We investigated the usefulness of foscarnet in patients who underwent related allogeneic HSCT. Foscarnet was used in 320 patients with a median age of 45 years (range 15–72). The purpose of administration was CMV disease in 65, preemptive use in 248 and prophylaxis in 7. Totally, 194 patients had a history of prior ganciclovir treatment. The reason for foscarnet use was insufficient therapeutic effect of prior ganciclovir in 99, and adverse event including myelosuppression in 95. The response rate in symptom was 52% for the CMV disease patients. Antigenemia disappeared in 77% of the preemptive treatment and improved in 13% of the patients. No outbreak of CMV disease was recognized. The total effectiveness of therapeutic and preemptive use was significantly higher for patients without prior ganciclovir (91 vs. 76%, P = 0.001). Adverse events of grade 3 or higher were recognized in 24%, including electrolyte abnormalities in 11%, neutropenia in 8%, and thrombocytopenia in 8%. Renal damage was only observed in 3% of patients. Foscarnet was concluded to be a safe and effective anti-CMV agent and to be a suitable alternative to ganciclovir.

Keywords

Cytomegalovirus infection Foscarnet Blood and marrow transplantation Efficacy Adverse reaction 

Notes

Acknowledgments

This work was supported in part by Health and Labour Sciences Research Grants for Clinical Cancer Research from the Ministry of Health, Labour, and Welfare, Japan. The authors would like to thank the staff of the Data Center of the Japan Society for Hematopoietic Cell Transplantation and the following collaborating institutions for providing patient data and specimens: Hokkaido University; Sapporo Hokuyu Hospital; Asahikawa Medical College; Hakodate Municipal Hospital; Aomori Prefectural Central Hospital; Tohoku University; Akita University; Kita-Fukushima Medical Center; Tsukuba University; Gunma University; Saitama Medical University International Medical Center; Matsudo Municipal Hospital; National Cancer Center Hospital; Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital; Jikei University; Keio University; Tokyo Women’s Medical University; Teikyo University; NTT Kanto Medical Center; Toranomon Hospital; Tokyo Medical and Dental University; National Hospital Organization Tokyo Medical Center; Yokohama City University; Kanagawa Cancer Center; Yokohama City University Medical Center; St. Marianna University; St. Marianna University Yokohama City Seibu Hospital; Niigata University; Niigata Cancer Center; Nagaoka Red Cross Hospital; Toyama Prefectural Central Hospital; Kanazawa University; Shinshu University; Gifu University; Hamamatsu Medical University; Meitetsu Hospital; Nagoya City University; Social insurance Chukyo Hospital; Mie University; Suzuka Kaisei Hospital; Kyoto University; Social Insurance Kyoto Hospital; Kyoto City Hospital; Kyoto Katsura Hospital; Osaka Medical Center For Cancer And Cardiovascular Diseases; Kinki University; Hyogo College of Medicine; Osaka City University; Matsushita Memorial Hospital; Rinku General Medical Center Izumisano Municipal Hospital; Osaka Medical College; Kansai Medical University Hirakata Hospital; Hyogo Cancer Center; Shimane Prefectural Central Hospital; Kurashiki Central Hospital; Okayama University; National Hospital Organization Kure Medical Center; Yamaguchi University; Tokushima University; Kyushu University; Hamanomachi Hospital; Nagasaki University; Sasebo City General Hospital; National Hospital Organization Nagasaki Medical Center; National Hospital Organization Kumamoto Medical Center; Oita University.

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Copyright information

© The Japanese Society of Hematology 2010

Authors and Affiliations

  • Maiko Asakura
    • 1
  • Kazuhiro Ikegame
    • 2
  • Satoshi Yoshihara
    • 2
  • Shuichi Taniguchi
    • 3
  • Takehiko Mori
    • 4
  • Tetsuya Etoh
    • 5
  • Akiyoshi Takami
    • 6
  • Takashi Yoshida
    • 7
  • Takahiro Fukuda
    • 8
  • Kazuo Hatanaka
    • 9
  • Heiwa Kanamori
    • 10
  • Toshiaki Yujiri
    • 11
  • Yoshiko Atsuta
    • 1
  • Hisashi Sakamaki
    • 12
  • Ritsuro Suzuki
    • 1
  • Hiroyasu Ogawa
    • 2
  1. 1.Department of HSCT Data Management and BiostatisticsNagoya University School of MedicineNagoyaJapan
  2. 2.Division of Hematology, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan
  3. 3.Department of HematologyToranomon HospitalTokyoJapan
  4. 4.Division of Hematology, Department of MedicineKeio University School of MedicineTokyoJapan
  5. 5.Department of HematologyHamanomachi HospitalFukuokaJapan
  6. 6.Department of Cellular Transplantation BiologyKanazawa University Graduate School of MedicineKanazawaJapan
  7. 7.Hematology DepartmentToyama Prefectural HospitalToyamaJapan
  8. 8.Hematopoietic Stem Cell Transplantation DivisionNational Cancer Center HospitalTokyoJapan
  9. 9.Department of Internal MedicineRinku General Medical CenterIzumisanoJapan
  10. 10.Department of HematologyKanagawa Cancer CenterYokohamaJapan
  11. 11.Third Department of Internal MedicineYamaguchi University School of MedicineUbeJapan
  12. 12.Department of HematologyTokyo Metropolitan Komagome HospitalTokyoJapan

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