NEW ORLEANS--Ganciclovir (Cytovene) protects allogeneic bone marrow
transplant (BMT) recipients in the early postoperative period, but
late infection with cytomegalovirus (CMV) continues to cause serious
problems, Helen C. Maltezou, MD, reported at the 36th Interscience
Conference on Antimicrobial Agents and Chemotherapy (ICAAC).
Dr. Maltezou and her colleagues at the University of Texas M.D.
Anderson Cancer Center reviewed the incidence and mortality
associated with CMV disease occurring from 100 to 365 days
post-transplant in 156 adults with leukemia and lymphoma who received
ganciclovir prophylaxis during the first 100 days post-transplant.
Most of the patients were given ganciclovir 5 mg/kg intravenously
either three or five times a week. Either the donor or the patient
was seropositive for CMV.
Late CMV disease developed in 16 patients (13%) at a median of 200
days post-transplant; 14 had pneumonia, one had gastrointestinal
disease, and one had both. A serious concurrent infection was present
in 11 of the 16 patients, said Dr. Maltezou, of the Section of
Of seven patients getting peripheral blood stem cell (PBSC)
transplant, four (57%) developed CMV disease, a much higher
percentage than the 8% receiving bone marrow transplant.
Outcome was grim, as 12 patients (71%) died. Concurrent infection did
not increase the odds of dying, Dr. Maltezou said.
Statistically significant risk factors for the development of late
CMV disease were age more than 40 years, the use of an unrelated
donor, the use of antithymocyte globulin, CMV shedding during the
first 100 days post-transplant, and the development of acute or
chronic graft-versus-host disease.
5 Times a Week Better Than 3
A related study from the M.D. Anderson Cancer Center compared the
efficacy of 5 mg/kg of ganciclovir in two different schedules
administered from engraftment to 100 days post-transplant.
The results showed that five times per week was more effective than
three times per week. The study included 215 adult allogeneic bone
marrow and PBSC transplant recipients.
Active CMV infection occurred in 41% of patients receiving the drug
three times per week but in only 21% of patients getting the drug
five times per week, Dr. Maltezou reported.
CMV disease occurred in 16% versus 4%, and CMV-related mortality was
12% versus 1.5%, respectively, for three doses compared with five.
Overall mortality was no different.
Besides three-times-per-week dosing, other risk factors for CMV
disease in the first 100 days post-transplant, in this cohort, were
T-cell-depleted marrow and the use of FK 506 in graft-versus-host
disease prophylaxis, Dr. Maltezou commented.