Incidence, Risk Factors, and Outcome of Cytomegalovirus Infection and Disease in Patients Receiving Prophylaxis with Oral Valganciclovir or Intravenous Ganciclovir after Umbilical Cord Blood Transplantation

Autores de IIS La Fe

• Pau Montesinos Fernández

  Autor

• Jaime Sanz Caballer

  Autor

• Jose Ignacio Lorenzo Herrero

  Autor

• María Leonor Senent Peris

  Autor

• Jesus Antonio Martinez Dominguez

  Autor

• Isidro Jarque Ramos

  Autor

• Miguel Salavert Lletí

  Autor

• Federico Moscardo Garcia

  Autor

• 

  Javier De La Rubia Comos

  Autor

• Luis Larrea Gonzalez

  Autor

• Miguel Ángel Sanz Alonso

  Autor

• Guillermo Sanz Santillana

  Autor

Participantes ajenos a IIS La Fe

• Cantero, Susana
• Martin, Guillermo
• Saavedra, Silvana
• Palau, Javier
• Romero, Monica
• Montava, Alberto
• Cordoba, Juan
• Gomez, Lola
• Weiss, Shirley

Grupos

• Hematología y Hemoterapia

Abstract

There is no information on the efficacy and safety of anticytomegalovirus (CMV) prophylaxis with intravenous ganciclovir or oral valganciclovir after unrelated cord-blood transplantation (UCBT). This issue was addressed in 151 adults (117 CMV-seropositive) undergoing UCBT at a single institution. The first 38 CMV-seropositive recipients were assigned to receive prophylactic ganciclovir, and the next 79 were given valganciclovir after engraftment. The cumulative incidence (0) of CMV infection and disease was similar in patients receiving valganciclovir or ganciclovir (59% versus 55%, P=.59; and 9% versus 18%, P=.33, respectively). The toxicity profile and Cl of nonrelapse mortality (CMV) and infection-related mortality did not differ between drugs. Patients receiving valganciclovir required fewer visits to the day hospital (P=.04). The CI of CMV infection and disease in 34 CMV-seronegative recipients was 12% and 6%, indicating that tight CMV monitoring is mandatory in this subset. The recipient's CMV serostatus, acute and extensive chronic graft-versus-host disease (aGVHD, cGVHD) were the main risk factors for CMV infection, and aGVHD for CMV disease. This study suggests that prophylaxis with oral valganciclovir is as safe and effective as intravenous ganciclovir for preventing CMV infection and disease after UCBT, but valganciclovir reduces the use of hospital resources. Biol Blood Marrow Transplant 15: 730-740 (2009) (C) 2009 American Society for Blood and Marrow Transplantation

Keywords

• Cytomegalovirus; Umbilical cord blood transplantation; Valganciclovir; Ganciclovir; Prophylaxis