Journal Article

Pre-transplant ganciclovir and post transplant high-dose valacyclovir reduce CMV infections after alemtuzumab-based conditioning

Thompson, K, Pursell, K, Zimmerman, T, Larson, R A, Kline, J, Pollyea, D A, van Besien, K, Godley, L, Rich, E, Artz, A, Stock, W

2006

Overview

Alemtuzumab (Campath-1H)-based conditioning regimens are effective in preventing GVHD, but are associated with very high rates of cytomegalovirus (CMV) infection, a major limitation to their use. We evaluated 85 patients receiving conditioning with fludarabine 30 mg/m 2 /day (day −7 to day −3), alemtuzumab 20 mg/day (day −7 to day −3), and melphalan 140 mg/m 2 on day −2. The initial patients received post transplant CMV prophylaxis with high-dose acyclovir. A very high incidence of CMV viremia was observed as has been commonly reported after alemtuzumab-based conditioning. Sixty-seven subsequent patients received pre-transplant ganciclovir and high-dose valacyclovir after engraftment. The cumulative incidence of CMV infection in the valacyclovir cohort was 29%. This compared favorably to the cumulative incidence of 53% in patients receiving only acyclovir ( P =0.004) and to literature data. CMV prophylaxis with pre-transplant ganciclovir and high-dose valacyclovir after engraftment appears effective in preventing the excessive incidence of CMV infection after alemtuzumab-based conditioning regimens.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: Acyclovir / Acyclovir - administration & dosage / Acyclovir - analogs & derivatives / Adolescent / Adult / Aged / Alemtuzumab / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Antibodies, Monoclonal - administration & dosage / Antibodies, Monoclonal, Humanized / Antibodies, Neoplasm - administration & dosage / Antineoplastic Agents - administration & dosage / Antiviral agents / Antiviral Agents - administration & dosage / Antiviral drugs / Biological and medical sciences / Bone Marrow Transplantation - adverse effects / Bone marrow, stem cells transplantation. Graft versus host reaction / Cell Biology / Conditioning / Cytomegalovirus / Cytomegalovirus infections / Cytomegalovirus Infections - etiology / Cytomegalovirus Infections - prevention & control / Disease prevention / Dosage and administration / Drug therapy / Female / Fludarabine / Ganciclovir / Ganciclovir - administration & dosage / Graft-versus-host reaction / Hematologic Neoplasms - complications / Hematologic Neoplasms - therapy / Hematology / Humans / Incidence / Infections / Internal Medicine / Male / Medical sciences / Medicine / Medicine & Public Health / Melphalan / Middle Aged / Monoclonal antibodies / original-article / Prophylaxis / Public Health / Risk factors / Stem cell transplantation / Stem Cells / Transfusions. Complications. Transfusion reactions. Cell and gene therapy / Transplantation Conditioning / Transplantation, Homologous / Valacyclovir / Valine - administration & dosage / Valine - analogs & derivatives / Viremia