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.
|Issue number||11 PART I|
|State||Published - Dec 1 2000|