Open AccessCMV MANAGEMENT WITH SPECIFIC IMMUNOGLOBULINS: A MULTICENTRIC RETROSPECTIVE ANALYSIS ON 92 ALLOTRANSPLANTED PATIENTS.
Author(s) -
Michele Malagola,
Raffaella Greco,
Stella Santarone,
Annalisa Natale,
Anna Paola Iori,
Luisa Quatrocchi,
Walter Barbieri,
Antonella Bruzzese,
Salvatore Leotta,
Alessandra Carotti,
Antonio Pierini,
Simona Bernardi,
Enrico Morello,
Nicola Polverelli,
Alessandro Turra,
Federica Cattina,
Lisa Gandolfi,
Benedetta Rambaldi,
Francesca Lorentino,
Francesca Serio,
Giuseppe Milone,
Andrea Velardi,
Robin Foà,
Fabio Ciceri,
Domenico Russo,
Jacopo Peccatori
Publication year - 2019
Publication title -
mediterranean journal of hematology and infectious diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.682
H-Index - 31
ISSN - 2035-3006
DOI - 10.4084/mjhid.2019.048
Subject(s) - medicine , viremia , retrospective cohort study , adverse effect , transplantation , antibody , clinical trial , hematology , disease , cytomegalovirus , immunology , viral disease , human immunodeficiency virus (hiv) , herpesviridae
CMV represents one of the most serious life-threatening complications of allogeneic stem cell transplantaion (allo-SCT). Pre-emptive treatment is highly effective, but toxicity and repetitive reactivation of CMV represent a major challenge in the clinical practice. The use of anti-CMV specific immunoglobulins (Megalotect) is controversial.
We retrospectively collected data on 92 patients submitted to allo-SCT for hematological malignancies, in whom Megalotect was used either for prophylaxis (n=14) or with pre-emptive therapy (n=78). All the patients were considered at high-risk of developing CMV reactivation and CMV disease.
The treatment was well tolerated, with no reported infusion reactions, nor other adverse events. None of the 14 cases treated with Megalotect as prophylaxis developed CMV reactivation. 51/78 (65%) patients who received Megalotect during pre-emptive treatment achieved complete clearance of CMV viremia, and 14/51 patients (29%) developed a breakthroug CMV infection. 7/78 patients (9%) developed CMV disease. The projected 1-year OS, 1-year TRM and 1-year RR is 74%, 15% and 19%, respectively. No differences were observed in terms of OS, TRM and RR by comparing patients who achieved a complete response after treatment versus those who did not..
These retrospective data suggest that Megalotect is safe and well tolerated. When used as prophylaxis, no CMV reactivation was recorded. We have no conclusive data regarding its efficacy in reducing the cumulative dose of anti-CMV specific drugs in the pre-emptive setting. Further prospective trials are warrented to identify the best setting of patients who can benefit from Megalotect alone or in addition to anti-CMV specific drugs.