Abstract
Alemtuzumab (Campath-1H)-based conditioning regimens are effective in preventing GVHD, but are associated with very high rates of cytomegalovirus (CMV) infection, a major limitation to their use. We evaluated 85 patients receiving conditioning with fludarabine 30 mg/m2/day (day −7 to day −3), alemtuzumab 20 mg/day (day −7 to day −3), and melphalan 140 mg/m2 on day −2. The initial patients received post transplant CMV prophylaxis with high-dose acyclovir. A very high incidence of CMV viremia was observed as has been commonly reported after alemtuzumab-based conditioning. Sixty-seven subsequent patients received pre-transplant ganciclovir and high-dose valacyclovir after engraftment. The cumulative incidence of CMV infection in the valacyclovir cohort was 29%. This compared favorably to the cumulative incidence of 53% in patients receiving only acyclovir (P=0.004) and to literature data. CMV prophylaxis with pre-transplant ganciclovir and high-dose valacyclovir after engraftment appears effective in preventing the excessive incidence of CMV infection after alemtuzumab-based conditioning regimens.
Similar content being viewed by others
References
Chakraverty R, Peggs K, Chopra R, Milligan DW, Kottaridis PD, Verfuerth S et al. Limiting transplantation-related mortality following unrelated donor stem cell transplantation by using a nonmyeloablative conditioning regimen. Blood 2002; 99: 1071–1078.
Kottaridis PD, Milligan DW, Chopra R, Chakraverty RK, Chakrabarti S, Robinson S et al. In vivo CAMPATH-1H prevents graft-versus-host disease following nonmyeloablative stem cell transplantation. Blood 2000; 96: 2419–2425.
Chakrabarti S, Mackinnon S, Chopra R, Kottaridis PD, Peggs K, O'Gorman P et al. High incidence of cytomegalovirus infection after nonmyeloablative stem cell transplantation: potential role of Campath-1H in delaying immune reconstitution. Blood 2002; 99: 4357–4363.
van Besien K, Artz A, Smith S, Cao D-C, Rich S, Godley L et al. Fludarabine melphalan alemtuzumab (Campath-1H®) conditioning in adults with advanced AML and MDS. Excellent outcomes in patients with standard risk disease. J Clin Oncol 2005; 23: 5728–5738.
Ljungman P, De la Camara R, Milpied N, Volin L, Russell CA, Crisp A et al. Randomized study of valacyclovir as prophylaxis against cytomegalovirus reactivation in recipients of allogeneic bone marrow transplants. Blood 2002; 99: 3050–3056.
van Besien K, Smith S, Odenike O, Daugherty C, Zimmerman T, Thirman MJ et al. Alemtuzumab (Campath)-based GVHD prophylaxis leads to improved survival after allogeneic transplantation for patients with advanced hematologic malignancies. Blood 102; 2611: 2003.
Meyers JD, Reed EC, Shepp DH . Acyclovir for prevention of cytomegalovirus infection and disease after allogeneic marrow transplantation. N Engl J Med 1988; 318: 70–75.
Verma A, Devine S, Morrow M, Chen YH, Mihalov M, Peace D et al. Low incidence of CMV viremia and disease after allogeneic peripheral blood stem cell transplantation. Role of pretransplant ganciclovir and post-transplant acyclovir. Bone Marrow Transplant 2003; 31: 813–816.
Boeckh M, Nichols WG, Papanicolaou G, Rubin R, Wingard JR, Zaia J . Cytomegalovirus in hematopoietic stem cell transplant recipients: current status, known challenges, and future strategies. Biol Blood Marrow Transplant 2003; 9: 543–558.
Reusser P, Einsele H, Lee J, Volin L, Rovira M, Engelhard D et al. Randomized multicenter trial of foscarnet versus ganciclovir for preemptive therapy of cytomegalovirus infection after allogeneic stem cell transplantation. Blood 2002; 99: 1159–1164.
Atkinson K, Downs K, Golenia M, Biggs J, Marshall G, Dodds A et al. Prophylactic use of ganciclovir in allogeneic bone marrow transplantation: Absence of clinical cytomegalovirus infection. Brit J Haematol 1991; 79: 57–62.
Winston DJ, Ho WG, Bartoni K, Du Mond C, Ebeling DF, Buhles WC et al. Ganciclovir prophylaxis of cytomegalovirus infection and disease in allogeneic bone marrow transplant recipients: Results of a placebo-controlled, double-blind trial. Ann Int Med 1993; 118: 179–184.
Acknowledgements
Supported in part by a Grant from Berlex pharmaceuticals and by NCI Grant 1-R21 CA 101337-01.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kline, J., Pollyea, D., Stock, W. et al. Pre-transplant ganciclovir and post transplant high-dose valacyclovir reduce CMV infections after alemtuzumab-based conditioning. Bone Marrow Transplant 37, 307–310 (2006). https://doi.org/10.1038/sj.bmt.1705249
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1705249
- Springer Nature Limited
Keywords
This article is cited by
-
Fludarabine-based reduced intensity conditioning transplants have a higher incidence of cytomegalovirus reactivation compared with myeloablative transplants
Bone Marrow Transplantation (2010)
-
Reduced-intensity transplantation for lymphoma
Current Treatment Options in Oncology (2006)