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Post-Transplant Events

Preemptive therapy with ganciclovir 5 mg/kg once daily for cytomegalovirus infection after unrelated cord blood transplantation

Bone Marrow Transplantation volume 41, pages 371–376 (2008)Cite this article

Abstract

The efficacy and safety of preemptive therapy using ganciclovir (GCV) 5 mg/kg once daily for CMV infection after unrelated cord blood transplantation (CBT) were studied. The initial preemptive therapy with GCV 5 mg/kg once daily led to resolution of CMV antigenemia in 25 of 34 patients (74%). In the remaining 9 patients (26%), antigenemia resolved after dose-escalation of GCV or change to foscarnet therapy. Recurrence of antigenemia was seen in 18 patients (53%). A total of 12 patients received the second preemptive therapy with GCV 5 mg/kg once daily, which led to resolution of antigenemia in 11 of 12 patients (92%). The remaining 1 patient (8%) required change to foscarnet therapy. None of 34 patients developed CMV disease. Neutropenia with an absolute neutrophil number of less than 1 and 0.5 × 109 per liter after GCV therapy occurred in 12 (35%) and 1 (3%) patients, respectively, after the initial therapy, and in 2 (17%) and 0 (0%) patients, respectively, after the second therapy. No patients developed neutropenic fever or secondary graft failure after GCV therapy. There were no deaths directly attributable to GCV therapy. The present study suggests that antigenemia-based preemptive strategy using GCV 5 mg/kg once daily is feasible and effective for CBT recipients.

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References

  1. Forman SJ, Zaia JA . Treatment and prevention of cytomegalovirus pneumonia after bone marrow transplantation: where do we stand? Blood 1994; 83: 2392–2398.

    CAS  PubMed  Google Scholar 

  2. Boeckh M, Nichols WG, Papanicolaou G, Rubin R, Wingard JR, Zaia J . Cytomegalovirus in hematopoietic stem cell transplant recipients: current status, known challenges, and future strategies. Biol Blood Marrow Transplant 2003; 9: 543–558.

    Article  Google Scholar 

  3. Ljungman P, Reusser P, de la Camara R, Einsele H, Engelhard D, Ribaud P et al. Management of CMV infections: recommendations from the infectious diseases working party of the EBMT. Bone Marrow Transplant 2004; 33: 1075–1081.

    Article  CAS  PubMed  Google Scholar 

  4. Salzberger B, Bowden RA, Hackman RC, Davis C, Boeckh M . Neutropenia in allogeneic marrow transplant recipients receiving ganciclovir for prevention of cytomegalovirus disease: risk factors and outcome. Blood 1997; 90: 2502–2508.

    CAS  PubMed  Google Scholar 

  5. Vij R, Khoury H, Brown R, Goodnough LT, Devine SM, Blum W et al. Low-dose short-course intravenous ganciclovir as pre-emptive therapy for CMV viremia post allo-PBSC transplantation. Bone Marrow Transplant 2003; 32: 703–707.

    Article  CAS  PubMed  Google Scholar 

  6. Verkruyse LA, Storch GA, Devine SM, Dipersio JF, Vij R . Once daily ganciclovir as initial pre-emptive therapy delayed until threshold CMV load >10000 copies/ml: a safe and effective strategy for allogeneic stem cell transplant patients. Bone Marrow Transplant 2006; 37: 51–56.

    Article  CAS  Google Scholar 

  7. Kanda Y, Mineishi S, Saito T, Saito A, Ohnishi M, Niiya H et al. Response-oriented preemptive therapy against cytomegalovirus disease with low dose ganciclovir: a prospective evaluation. Transplantation 2002; 73: 568–572.

    Article  CAS  PubMed  Google Scholar 

  8. Laughlin MJ, Eapen M, Rubinstein P, Wagner JE, Zhang MJ, Champlin RE et al. Outcomes after transplantation of cord blood or bone marrow from unrelated donors in adults with leukemia. N Engl J Med 2004; 351: 2265–2275.

    Article  CAS  Google Scholar 

  9. Rocha V, Labopin M, Sanz G, Arcese W, Schwerdtfeger R, Bosi A et al. Transplants of umbilical-cord blood or bone marrow from unrelated donors in adults with acute leukemia. N Engl J Med 2004; 351: 2276–2285.

    Article  CAS  Google Scholar 

  10. Arcese W, Rocha V, Labopin M, Sanz G, Iori AP, de Lima M et al. Unrelated cord blood transplants in adults with hematologic malignancies. Haematologica 2006; 91: 223–230.

    Google Scholar 

  11. Albano MS, Taylor P, Pass RF, Scaradavou A, Ciubotariu R, Carrier C et al. Umbilical cord blood transplantation and cytomegalovirus: posttransplantation infection and donor screening. Blood 2006; 108: 4275–4282.

    Article  CAS  Google Scholar 

  12. Tomonari A, Iseki T, Ooi J, Takahashi S, Shindo M, Ishii K et al. Cytomegalovirus infection following unrelated cord blood transplantation for adult patients: a single institute experience in Japan. Br J Haematol 2003; 121: 304–311.

    Article  PubMed  Google Scholar 

  13. Tomonari A, Tsukada N, Takahashi S, Ooi J, Konuma T, Kobayashi T et al. Early-onset pulmonary complication showing organizing pneumonia pattern after cord blood transplantation in adults. Int J Hematol 2007; 85: 364–366.

    Article  PubMed  Google Scholar 

  14. Takahashi S, Iseki T, Ooi J, Tomonari A, Takasugi K, Shimohakamada Y et al. Single-institute comparative analysis of unrelated bone marrow transplantation and cord blood transplantation for adult patients with hematologic malignancies. Blood 2004; 104: 3813–3820.

    Article  CAS  Google Scholar 

  15. Tomonari A, Iseki T, Takahashi S, Ooi J, Yamada T, Takasugi K et al. Ganciclovir-related neutropenia after preemptive therapy for cytomegalovirus infection: comparison between cord blood and bone marrow transplantation. Ann Hematol 2004; 83: 573–577.

    PubMed  Google Scholar 

  16. Saavedra S, Sanz GF, Jarque I, Moscardo F, Jimenez C, Lorenzo I et al. Early infections in adult patients undergoing unrelated donor cord blood transplantation. Bone Marrow Transplant 2002; 30: 937–943.

    Article  CAS  PubMed  Google Scholar 

  17. Sommadossi JP, Bevan R, Ling T, Lee F, Mastre B, Chaplin MD et al. Clinical pharmacokinetics of ganciclovir in patients with normal and impaired renal function. Rev Infect Dis 1988; 10: S507–514.

    Article  PubMed  Google Scholar 

  18. Harris DT, Schumacher MJ, Locascio J, Besencon FJ, Olson GB, DeLuca D et al. Phenotypic and functional immaturity of human umbilical cord blood T lymphocytes. Proc Natl Acad Sci USA 1992; 89: 10006–10010.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors thank Maki Monna-Oiwa for her secretarial assistance. We also thank the Kobayashi Foundation for financial support.

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Authors and Affiliations

  1. Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    A Tomonari, S Takahashi, J Ooi, N Tsukada, T Konuma, T Kobayashi, K Takasugi, T Iseki, A Tojo & S Asano

  2. Integrative Bioscience and Biomedical Engineering, School of Science and Engineering, Waseda University, Tokyo, Japan

    S Asano

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  1. A Tomonari
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  2. S Takahashi
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  3. J Ooi
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  4. N Tsukada
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  5. T Konuma
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  6. T Kobayashi
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  7. K Takasugi
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  8. T Iseki
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Correspondence to A Tomonari.

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Tomonari, A., Takahashi, S., Ooi, J. et al. Preemptive therapy with ganciclovir 5 mg/kg once daily for cytomegalovirus infection after unrelated cord blood transplantation. Bone Marrow Transplant 41, 371–376 (2008). https://doi.org/10.1038/sj.bmt.1705910

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  • DOI: https://doi.org/10.1038/sj.bmt.1705910

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