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Viral Infections

Dose-adjusted preemptive therapy for cytomegalovirus disease based on real-time polymerase chain reaction after allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 29, pages 777–782 (2002)Cite this article

Abstract

We have prospectively evaluated the efficacy of real-time PCR-guided preemptive therapy for CMV diseases in allogeneic hematopoietic stem cell transplant recipients with grades II–IV acute GVHD. The dose of ganciclovir was adjusted according to the viral load determined by real-time polymerase chain reaction (PCR). On detecting CMV reactivation in the plasma, ganciclovir was initiated at a dose of 5 mg/kg body weight once daily, and the dose was increased to twice daily if viral load continued to increase after initiating ganciclovir. In 39 evaluable patients, CMV reactivation assessed by real-time PCR became positive in 30 (77%). One developed CMV gastroenteritis before PCR became positive. Thus the remaining 29 patients were treated preemptively with ganciclovir. The dose of ganciclovir was increased in 12 patients (41%) of preemptively treated patients for increasing viral load. CMV diseases were diagnosed in two patients (one gastroenteritis and one retinitis), and late CMV disease was diagnosed in one patient (gastritis). The treatment was generally well-tolerated, but three patients (10%) developed neutropenia (neutrophil count less than 1.0 × 109/l). In conclusion, real-time PCR-guided preemptive therapy with decreased dose of ganciclovir is feasible and does not increase the frequency of CMV diseases if the dose is adjusted according to the viral load.

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Acknowledgements

We thank the staff doctors and nurses in the KEIO BMT Program for their excellent patient care. This work was supported in part by grants from the Japan Society for the Promotion of Science (JSPS-RFTF 97L00701) and the Ministry of Education, Science and Culture of Japan.

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Authors and Affiliations

  1. Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

    T Mori, S Okamoto, R Watanabe, R Yamazaki, T Nakazato, N Sato, T Iguchi, H Nagayama, N Takayama & Y Ikeda

  2. Division of Gastroenterology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

    T Yajima, Y Iwao & T Hibi

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  1. T Mori
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  2. S Okamoto
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Mori, T., Okamoto, S., Watanabe, R. et al. Dose-adjusted preemptive therapy for cytomegalovirus disease based on real-time polymerase chain reaction after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 29, 777–782 (2002). https://doi.org/10.1038/sj.bmt.1703542

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