Cmv infection following allogeneic peripheral blood stem cell transplantation (allo-pbsct): changing patterns and low dose short course (ldsc) gancyclovir (gcv)as an effective nontoxic presumtive therapy (pt)regimen

Ravi Vij, Douglas Adkins, Randy Brown, Hanna Khoury, Peter Westervelt, Lawrence Goodnough, Muneer Abidi

Research output: Contribution to journalArticle

Abstract

In contrast to allogeneic bone marrow transplantation (allô BMT), there is a paucity of data on CMV infection and efficacy of PT regimens following allo-PBSCT. Guided by the allo-BMT experience, most centers use GCV 10mg/kg/d given in two divided doses for 1 -2 weeks, followed by 5 mg/kg/d for 100-120 days as PT for CM V viremia post transplant. Unfortunately, with this regimen neutropenia (a negative predictor for survival) occurs in upto 60% of pts. We report here on the patterns of CMV infection and the efficacy of LDSC GCV given at a dose of 5mg/kg once daily for 21 days only in a cohort of 235 patients (pts)who underwent allo-PBSCT at our institution between Sept 94 and April 2000.175 recipient-donor pairs were CMV seropositive. An initial episode of viremia (detected by shell vial/tube culture) occurred in 78/175 (45%) at median 35(17-445 )days.60 patients received PT with LDSC GCV. 57/60 (95%) pts completed the 21 day course of PT. LDSC GCV cleared viremia by d#7 in 16/23 (70%)and by d#14 in 18/24 (82%) for whom follow-up cultures were available at these time points. A second episode of viremia occurred in 20/60 (33%)at d#80 (50-174)and a third episode in 6/60 (10%)at d#137 (103-534). Overall, 12/175 (7%) developed CMV disease (pneumonia 10, colitis 2) at 170 (41 -855)d. 8/12 pts (66%) with CMV disease died. CMV disease occurred late ( d# 100) in 7/12 pts.6/7 (85%) of patients with late CMV developed evidence of organ involvement in absence of CMV viremia. Among the patients receiving LDSC GCV 5/60 (8%) developed disease (4 pneumonia, 1 colitis) at 211 (63-487)d. No pt developed disease while receiving PT. Among pts with recurrent viremia only 1 pt later developed CMV disease and died. Median ANC and platelet counts pre LDSC GCV were 6250 (700-23,500)/cumm and 89,000 (6000-308,000)/cumm respectively. Median ANC and platelet counts post LDSC GCV were 3690 (740-14,200)/cumm and 82,000 (8000-269,000)/cumm respectively. No pt had to initiate growth factors or receive platelet transfusion for GCV induced cytopenia. CONCLUSION: A high incidence of late CMV disease in absence of CMV viremia was observed in this cohort of patients following allô PBSCT. LDSC GCV is extremely welltolerated and cost-effective as PT for CMV viremia following allo-PBSCT.

Original languageEnglish
Pages (from-to)189a
JournalBlood
Volume96
Issue number11 PART I
StatePublished - Dec 1 2000

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