Prevention of Cytomegalovirus Infection by Valaciclovir after Allogeneic Bone Marrow Transplantation from an Unrelated Donor
- 79 Downloads
In this prospective single-center study, we evaluated the efficacy and safety of valaciclovir (VACV) in the prevention of cytomegalovirus (CMV) infection after allogeneic bone marrow transplantation (BMT).The study population consisted of 12 patients who underwent allogeneic BMT from an unrelated donor. Patients received acyclovir (ACV) intravenously until they became able to take VACV orally.VACV was administered at a daily dose of 3000 mg and continued until day 100. CMV infection was monitored by CMV antigenemia assay and real-time polymerase chain reaction analysis of plasma. Thirty-five patients who did not receive any form of CMV chemoprophylaxis served as control subjects. CMV infection was detected in 4 (33.3%) of the 12 patients and in 24 (68.6%) of the 35 control subjects (P > .05). The onset of CMV infection was significantly delayed in the VACV group (median, day 43) compared with the control group (median, day 28.5; P > .01). Gastrointestinal symptoms as an adverse event due to VACV administration were observed in 2 patients. The plasma levels of ACV after VACV administration were measured in 8 patients and were similar to those in the healthy subjects. In conclusion,VACV shows normal absorption, even in the early posttransplantation period, and may prevent or delay CMV infection effectively and safely in allogeneic BMT recipients.
Key wordsCytomegalovirus Valaciclovir Allogeneic BMT
Unable to display preview. Download preview PDF.
- 2.Winston DJ, Ho WG, Champlin RE. Cytomegalovirus infections after allogeneic bone marrow transplantation. Rev Infect Dis. 1999;12(suppl 7):S776-S792.Google Scholar
- 3.Ljungman P, Reusser P, de la Camara R, et al, for the Infectious Disease Working Party of the European Group for Blood and Marrow Transplantation. Management of CMV infections: recommendations from the infectious diseases working party of the EBMT. Bone Marrow Transplant. 2004;33:1075–1081.CrossRefGoogle Scholar
- 7.Boeckh M, Gooley TA, Myerson D, Cunningham T, Schoch G, Bowden RA. Cytomegalovirus pp65 antigenemia-guided early treatment with ganciclovir versus ganciclovir at engraftment after allogeneic marrow transplantation: a randomized double-blind study. Blood. 1996;88:4063–4071.Google Scholar
- 8.Schmidt GM, Horak D, Niland JC, Duncan SR, Forman SJ, Zaia JA. A randomized, controlled trial of prophylactic ganciclovir for cytomegalovirus pulmonary infection in recipients of allogeneic bone marrow transplants: the City of Hope-Stanford-Syntex CMV Study Group. N Engl J Med. 1991;324:1005–1011.CrossRefGoogle Scholar
- 20.Ljungman P, de la Camara R, Milpied N, et al, and the Valacyclovir International Bone Marrow Transplant Study Group. Randomized study of valacyclovir as prophylaxis against cytomegalovirus reactivation in recipients of allogeneic bone marrow transplants. Blood. 2002;99:3050–3056.CrossRefGoogle Scholar
- 21.Winston DJ, Yeager AM, Chandrasekar PH, Snydman DR, Petersen FB, Territo MC, and the Valacyclovir Cytomegalovirus Study Group. Randomized comparison of oral valacyclovir and intravenous ganciclovir for prevention of cytomegalovirus disease after allogeneic bone marrow transplantation. Clin Infect Dis. 2003;36:749–758.CrossRefGoogle Scholar
- 27.Feinberg JE, Hurwitz S, Cooper D, et al. A randomized, double-blind trial of valacyclovir prophylaxis for cytomegalovirus disease in patients with advanced human immunodeficiency virus infection: AIDS Clinical Trials Group Protocol 204/Glaxo Wellcome 123-014 International CMV Prophylaxis Study Group. J Infect Dis. 1998;177:48–56.CrossRefGoogle Scholar