Efficacy of preemptive treatment with a half-dose of ganciclovir for CMV infection after pediatric allogeneic hematopoietic stem cell transplantation

Abstract

Introduction: Cytomegalovirus (CMV) infection remains a major cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Ganciclovir has potent activity against CMV and has been used successfully to treat CMV infection in immunocompromised recipients. However, the suppression of bone marrow function associated with ganciclovir treatment has been of particular concern. We did acyclovir prevention in all patients, and preemptive treatment of CMV infection with a half-dose of ganciclovir in asymptomatic recipients of HSCT when CMV antigenemia level was under 10/200,000 cells. Methods: Preventive acyclovir was administered at all of the HSCT patients. Patients received a preemptive half-dose of IV ganciclovir (5mg/kg once daily, 6 days a week) when CMV antigenemia had been detected at least once in less than 10/200,000 cells. If CMV antigenemia had been detected in more than or equal to 10/200,000 cells, conventional ganciclovir induction therapy (5mg/kg every 12 hours) was administered. When the CMV antigenemia was checked to be negative twice at the routine antigenemia test per 3 days, we concluded that the antigenemia was cleared and terminated the treatment. Results: A total of 130 patients were evaluated. CMV antigenemia was detected in 87 (66.9%) patients. The median day of CMV detection was 31 (11-300) days after transplantation, and the median number of cells in CMV antigenemia was 2 (1-49)/200,000 cells. Seventy-four patients (85.1%) received preemptive treatment with a half-dose of ganciclovir. Twenty-three (31.1%) patients of those who initially received half-dose of ganciclovir needed following induction therapy because of increase in CMV antigenemia over 10/200,000 cells in spite of the preemptive treatment. In fifty-one (68.9%) patients, viral clearance was achieved which meant half dose GCV was sufficient for the treatment of CMV infection. Only two (2.7%) patient who started with half-dose ganciclovir treatment developed CMV retinitis. Conclusions: This article conclude preemptive treatment with half-dose ganciclovir for patients with CMV antigenemia whose level is under 10/200,000 cells could be a successful and safe approach for CMV infection after HSCT.