Valganciclovir as pre-emptive therapy for cytomegalovirus infection in allogeneic haematopoietic stem cell transplant recipients
Por:
Ruiz-Camps, I, Len, O, de la Camara, R, Gurgui, M, Martino, R, Jarque, I, Barrenetxea, C, de Heredia, CD, Batlle, M, Rovira, M, de la Torre, J, Torres, A, Aguilar, M, Espigado, I, Martin-Davila, P, Bou, G, Borrell, N, Aguado, JM, Pahissa, A
Publicada:
1 ene 2011
Resumen:
Background: In haematopoietic stem cell transplant (HSCT) recipients, cytomegalovirus (CMV) infection contributes significantly to morbidity and mortality in both the early and late post-transplant period. Ganciclovir (GCV) is the treatment of choice for CMV, but requires intravenous administration, a fact that complicates its long-term use. Oral valganciclovir (VGCV) and intravenous GCV were recently shown to have similar efficacy for pre-emptive CMV treatment in solid organ transplant recipients, but relatively limited data are available in HSCT recipients. The objectives of this study were to compare the efficacy of VGCV versus intravenous GCV or foscarnet (FOS) for pre-emptive therapy of active CMV infection in allogeneic HSCT and to determine the incidence of adverse effects and relapses.
Methods: This was a 2-year prospective, comparative cohort study in which 237 episodes of pre-emptive therapy for active CMV infection were collected in 166 allogeneic HSCT recipients out of 717 included in the Spanish Network for Research on Infection in Transplantation (RESITRA/REIPI) database. Intravenous GCV was the first-line treatment in 112 episodes, intravenous FOS in 38 episodes, and oral VGCV in 87 episodes.
Results: VGCV was used as pre-emptive therapy for active CMV infection in 87 episodes. Excluding episodes considered as relapse, VGCV was as successful (91.4% [74/81]) as GCV (83.7% [87/14]) or FOS (75.8% [25/33]). In the VGCV arm, 7 (8.6%) cases were considered treatment failures: 4 (4.9%) because of adverse events, 1 (1.2%) due to persistent viral activity and 2 (2.5%) based on clinical decision. There were also 6 (7.4%) cases of recurrent infection. No statistically significant differences were found when compared to GCV or FOS.
Conclusions: In allogeneic HSCT recipients, VGCV seemed effective and safe in the pre-emptive therapy of active CMV infection.
Filiaciones:
Ruiz-Camps, I:
Hosp Univ Vall dHebron, Barcelona, Spain
Len, O:
Hosp Univ Vall dHebron, Barcelona, Spain
de la Camara, R:
Hosp La Princesa, Madrid, Spain
Gurgui, M:
Hosp Sta Creu & St Pau, Barcelona, Spain
Martino, R:
Hosp Sta Creu & St Pau, Barcelona, Spain
Jarque, I:
Hosp La Fe, E-46009 Valencia, Spain
Barrenetxea, C:
Hosp Univ Vall dHebron, Barcelona, Spain
de Heredia, CD:
Hosp Univ Vall dHebron, Barcelona, Spain
Batlle, M:
Hosp Trias & Pujol, Badalona, Spain
Rovira, M:
Hosp Clin Barcelona, Barcelona, Spain
de la Torre, J:
Hosp Princesa Sofia, Cordoba, Spain
Torres, A:
Hosp Princesa Sofia, Cordoba, Spain
Aguilar, M:
Hosp Virgen Rocio, Seville, Spain
Espigado, I:
Hosp Virgen Rocio, Seville, Spain
Martin-Davila, P:
Hosp Ramon & Cajal, E-28034 Madrid, Spain
Bou, G:
Hosp Juan Canalejo, La Coruna, Spain
Borrell, N:
Hosp Son Dureta, Mallorca, Spain
Aguado, JM:
Hosp 12 Octubre, E-28041 Madrid, Spain
Pahissa, A:
Hosp Univ Vall dHebron, Barcelona, Spain
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