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Occurrence of adverse events caused by valganciclovir as pre‐emptive therapy for cytomegalovirus infection after allogeneic stem cell transplantation is reduced by low‐dose administration
Author(s) -
Takahata M.,
Hashino S.,
Nishio M.,
Sugita J.,
Shigematsu A.,
Onozawa M.,
Fujimoto K.,
Endo T.,
Kondo T.,
Tanaka J.,
Imamura M.,
Teshima T.
Publication year - 2015
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12456
Subject(s) - medicine , valganciclovir , gastroenterology , cytomegalovirus , transplantation , adverse effect , dosing , ganciclovir , immunology , human cytomegalovirus , herpesviridae , virus , viral disease
Background Pre‐emptive therapy with valganciclovir ( VGCV ) has become the standard therapy for preventing cytomegalovirus ( CMV ) infection after allogeneic hematopoietic stem cell transplantation ( HSCT ). The effectiveness of low‐dose VGCV (900 mg per day) has been shown to be equal to that of standard‐dose VGCV (900 mg twice daily); however, individualized optimal dosing and toxicity of VGCV have not been reported. Methods We conducted a retrospective study to evaluate the optimal dose of VGCV as pre‐emptive therapy for preventing CMV infection by comparing the frequency of adverse events ( AE s) and clinical efficacy in a low‐dose VGCV group with those in a standard‐dose VGCV group. Thirty‐eight patients who were administered VGCV because of CMV antigenemia after HSCT were analyzed. Results Neutropenia (standard‐dose group: 33%, low‐dose group: 15%, P = 0.26) and thrombocytopenia (standard‐dose group: 39%, low‐dose group: 15%, P = 0.14) were frequent AE s of VGCV , and a significantly higher frequency of overall AE s was detected in the standard‐dose group than in the low‐dose group ( P < 0.01). In comparison of dosage based on weight, dosage of VGCV >27 mg/kg was closely related to onset of AE s ( P = 0.04). Conclusions Low‐dose VGCV was not inferior in clinical efficacy, including clearance rate of CMV antigenemia and incidence of consequent CMV disease, to standard‐dose VGCV as was previously reported. Initial low‐dose VGCV for pre‐emptive CMV therapy markedly reduces hematologic toxicity and has clinical efficacy equivalent to that of standard‐dose VGCV . It is therefore reasonable for patients, except for noticeably overweight patients, to be given initial low‐dose VGCV .