High-dose acyclovir and pre-emptive ganciclovir to prevent cytomegalovirus disease in myeloablative and non-myeloablative allogeneic stem cell transplantation
| العنوان: | High-dose acyclovir and pre-emptive ganciclovir to prevent cytomegalovirus disease in myeloablative and non-myeloablative allogeneic stem cell transplantation |
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| المؤلفون: | Richard W. Childs, Minoo Battiwalla, Karoll J. Cortez, Austin John Barrett, Vee J. Gill, Ryotaro Nakamura, Nancy F. Hensel, Scott D. Solomon |
| المصدر: | Bone Marrow Transplantation |
| بيانات النشر: | Springer Science and Business Media LLC, 2002. |
| سنة النشر: | 2002 |
| مصطلحات موضوعية: | Adult, Male, Ganciclovir, Human cytomegalovirus, Transplantation Conditioning, Adolescent, high-dose acyclovir, pp65 antigenemia, Acyclovir, Cytomegalovirus, Antiviral Agents, Article, Cohort Studies, Viral Matrix Proteins, non-myeloablative stem cell transplantation, Risk Factors, Betaherpesvirinae, medicine, Humans, Transplantation, Homologous, Aciclovir, Child, Aged, Preparative Regimen, Peripheral Blood Stem Cell Transplantation, Transplantation, biology, business.industry, virus diseases, T cell-depleted stem cell transplantation, Hematology, Middle Aged, Phosphoproteins, biology.organism_classification, medicine.disease, Survival Analysis, surgical procedures, operative, Cytomegalovirus Infections, Chemoprophylaxis, Immunology, Drug Therapy, Combination, Female, Virus Activation, business, medicine.drug |
| الوصف: | We evaluated high-dose acyclovir and pre-emptive ganciclovir to prevent cytomegalovirus disease in myeloablative and non-myeloablative allogeneic stem cell transplantation. One hundred and seventy-four consecutive patients who were at risk for CMV infection (either recipient or donor seropositive) and received either intensive chemoradiotherapy and a T cell-depleted stem cell transplant followed by delayed add-back of donor T cells (TCDT: n = 98), or a non-myeloablative preparative regimen followed by an unmanipulated peripheral blood stem cell transplant (NMT: n = 76) from an HLA-identical sibling donor were studied. All received high-dose acyclovir (HDACV) from day - 7 for 3 months post-transplant in conjunction with weekly CMV pp65 antigenemia monitoring and pre-emptive treatment with intravenous immunoglobulin (not CMV-specific) and ganciclovir. The actuarial probabilities of developing pp65 antigenemia were 83 +/- 4% after TCDT and 41 +/- 6% after NMT (P < 0.00001) with reactivation occurring earlier in the TCDT group (the median 36 days vs 55 days). We observed no reactivation of CMV in seronegative recipients with a seropositive donor (n = 23). A total of 11 patients (5 in TCDT, 6 in NMT) developed CMV disease within 400 days after transplantation, and one death was clearly attributable to CMV interstitial pneumonitis (IP). This strategy was associated with effective control of CMV antigenemia in the majority of patients and near-complete eradication of fatal CMV IP. |
| تدمد: | 1476-5365 0268-3369 |
| DOI: | 10.1038/sj.bmt.1703648 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4c59eec6601c84705869c0c0be3c3353 https://doi.org/10.1038/sj.bmt.1703648 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....4c59eec6601c84705869c0c0be3c3353 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14765365 02683369 |
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| DOI: | 10.1038/sj.bmt.1703648 |