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Viral Infections

Risk-adapted pre-emptive therapy for cytomegalovirus disease in patients undergoing allogeneic bone marrow transplantation

Bone Marrow Transplantation volume 25, pages 765–769 (2000)Cite this article

Abstract

We prospectively evaluated a risk-adapted pre-emptive treatment with ganciclovir for CMV diseases in patients undergoing allogeneic bone marrow transplantation (BMT). High-level CMV antigenemia (10 or more positive cells on two slides) or CMV antigenemia at any level in patients with grade II–IV acute graft-versus-host disease (aGVHD) were chosen as risk factors. We also retrospectively evaluated virus reactivation in plasma using quantitative real-time polymerase chain reaction (PCR). Fifty patients were evaluable. None of the 27 patients with or without grade I aGVHD developed high-level CMV antigenemia or CMV disease. Among the 23 patients with grade II–IV aGVHD, 12 patients (52%) developed CMV antigenemia and were treated pre-emptively, of whom two developed CMV gastroenteritis or retinitis in spite of therapy. Six of the remaining 11 patients developed CMV gastroenteritis before CMV antigenemia was detectable. All of the eight patients with CMV diseases were successfully treated with ganciclovir and no deaths directly related to CMV disease occurred. In four of the seven evaluable patients with CMV gastroenteritis, real-time PCR was able to detect virus reactivation earlier than CMV antigenemia. Although our risk-adapted pre-emptive therapy effectively reduced CMV-related mortality, further refinements of this approach, particularly in the prevention of CMV gastroenteritis, may be achieved by incorporating real-time PCR. Bone Marrow Transplantation (2000) 25, 765–769.

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Acknowledgements

The authors thank the attending doctors, dedicated fellows, and nurses in Keio BMT program for providing excellent patient care. The authors also thank Dr John Wingard for his kind suggestions in preparing this manuscript. This work was supported in part by grants from the Japan Society for the Promotion of Science (JSPS-RFTF 97L00701) and the Ministry of Education, Science and Culture of Japan.

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Authors and Affiliations

  1. Division of Hematology, Keio University School of Medicine, Tokyo, Japan

    T Mori, S Okamoto, S Matsuoka, M Wakui, R Watanabe, A Ishida & Y Ikeda

  2. Division of Gastroenterology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

    T Yajima, Y Iwao & T Hibi

  3. Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan

    M Mukai

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  1. T Mori
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Mori, T., Okamoto, S., Matsuoka, S. et al. Risk-adapted pre-emptive therapy for cytomegalovirus disease in patients undergoing allogeneic bone marrow transplantation. Bone Marrow Transplant 25, 765–769 (2000). https://doi.org/10.1038/sj.bmt.1702227

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