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Cytomegalovirus surveillance and prevention in allogeneic bone marrow transplantation: Examination of a preemptive plan of ganciclovir therapy
Author(s) -
Mandanas Romeo A.,
Saez Ruben A.,
Selby George B.,
Confer Dennis L.
Publication year - 1996
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/(sici)1096-8652(199602)51:2<104::aid-ajh2>3.0.co;2-1
Subject(s) - ganciclovir , medicine , cytomegalovirus , betaherpesvirinae , bronchoalveolar lavage , pneumonia , transplantation , surgery , bone marrow , gastroenterology , immunology , human cytomegalovirus , herpesviridae , viral disease , lung , virus
Forty‐two cytomegalovirus (CMV)‐seropositive allogeneic marrow transplant patients or recipients of CMV‐seropositive marrow allografts were entered into a surveillance program to detect and treat CMV infection during the first 120 days posttransplant. CMV infection was detected at a mean time of day 50 in 21/37 (58%) patients who had surveillance cultures. Twelve of 42 (28%) received preemptive ganciclovir treatment for virus isolated from blood (9 patients) or from bronchoalveolar lavage fluid (3 patients), and all had no CMV‐associated sequelae. CMV disease was diagnosed in 5 patients (4 with pneumonia, 1 with gastroenteritis) who did not have positive cultures until the onset of their disease. CMV‐related mortality was 4/42 (10%). Patients who earlier manifested lung injury or diffuse alveolar hemorrhage (DAH) were significantly predisposed to subsequent CMV pneumonia ( P = 0.0013, Fisher's exact test) at a median onset of day 42. Restricted prophylactic use of ganciclovir in such patients may be indicated. Fifty percent of all patients never required ganciclovir during the surveillance period. When compared to a universal prophylaxis program of ganciclovir for the prevention of CMV disease, the use of ganciclovir in a preemptive strategy could avoid unnecessary therapy for a substantial number of patients and earn significant cost‐savings. © 1996 Wiley‐Liss, Inc.