CMV reactivation is commonly encountered after allogeneic SCT and can lead to significant morbidity in such patients (pts). Recent studies using Valacyclovir for the prophylactic treatment of CMV infection have shown safety and efficacy in renal transplan : and AIDS pts. The benefit of this approach in SCT has not yet been reported. W( hypothesized that Valacyclovir could be useful in the prevention of primary CMV reactivation or after successful treatment of reactivation (secondary prophylaxis) it allogeneic SCT pts. To evaluate our treatment approach we performed a cohort study. K pts received Valacyclovir (VG group) for CMV reactivation prophylaxis after high-dosf chemotherapy and allogeneic SCT for various hematological disorders (CML, AML, ALL and CLL) at VUMC between 9/98 and 3/00. Valacyclovir was administered at a dose 01 Igm orally three times a day adjusted to renal function. 16 other pts, transplanted betweer 9/93 and 3/00, were identified to serve as cohorts (CG group) matched by recipient anc donor CMV sero-status. All 32 pts were at risk for CMV reactivation with either recipient donor or both being CMV seropositive. 13 and 14 recipients were seropositive respectivelj in the VG and the CG groups. Valacyclovir was used as primary prophylaxis in 10 pts anc 6 received the drug as secondary prophylaxis after prior CMV reactivation was effective!) treated with either Ganciclovir or Foscarnet. Demographics of the VG and CG groups were statistically similar (p 0.05). Total number of pts receiving steroids for treatmen of GVHD was 14 in the VG and 13 in the CG groups. No pts died within the first 10( days in either group. Following transplant, the median day to obtain platelets 20,000/1 and ANC 500/L was respectively 17 and 18 days for the VG group vs 15.5 and 18 days for CG group. CMV reactivation was determined by testing of blood for antigenemiE using a commercially available immunofluorescence assay for CMV p65. For primary prophylaxis, only 3/10 VG group pts reactivated CMV compared to 13/16 in the CCJ group (p < 0.05). 1/6 pts while receiving Valacyclovir for secondary prophaxis reactivated compared to 4/13 CG pts (p 0.1). There was no significant difference in the adversel events between groups. Prophylaxis with Valacyclovir is safe and appears efficacious in1 preventing primary CMV reactivation in at-risk pts after allogeneic SCT. The small! sample size precluded conclusions about secondary prophylaxis but appears promising.! Larger studies are required to confirm the efficacy of this approach for prevention of primary or secondary reactivation of CMV after allogeneic SCT. !
|Original language||English (US)|
|Issue number||11 PART I|
|State||Published - Dec 1 2000|
ASJC Scopus subject areas
- Cell Biology