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

Takehiko Mori, Shinichiro Okamoto, S. Matsuoka, T. Yajima, Masatoshi Wakui, R. Watanabe, A. Ishida, Yasushi Iwao, M. Mukai, T. Hibi, Y. Ikeda

Research output: Contribution to journalArticle

90 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)765-769
Number of pages5
JournalBone Marrow Transplantation
Volume25
Issue number7
Publication statusPublished - 2000

Fingerprint

Homologous Transplantation
Cytomegalovirus
Bone Marrow Transplantation
Gastroenteritis
Graft vs Host Disease
Real-Time Polymerase Chain Reaction
Ganciclovir
Therapeutics
Viruses
Retinitis
Mortality

Keywords

  • CMV antigenemia
  • Cytomegalovirus
  • Ganciclovir
  • Pre-emptive therapy
  • Real-time PCR

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Risk-adapted pre-emptive therapy for cytomegalovirus disease in patients undergoing allogeneic bone marrow transplantation. / Mori, Takehiko; Okamoto, Shinichiro; Matsuoka, S.; Yajima, T.; Wakui, Masatoshi; Watanabe, R.; Ishida, A.; Iwao, Yasushi; Mukai, M.; Hibi, T.; Ikeda, Y.

In: Bone Marrow Transplantation, Vol. 25, No. 7, 2000, p. 765-769.

Research output: Contribution to journalArticle

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