Incidence, Risk Factors, and Outcome of Cytomegalovirus Infection and Disease in Patients Receiving Prophylaxis with Oral Valganciclovir or Intravenous Ganciclovir after Umbilical Cord Blood Transplantation

Pau Montesinos, Jaime Sanz, Susana Cantero, Ignacio Lorenzo, Guillermo Martín, Silvana Saavedra, Javier Palau, Mónica Romero, Alberto Montava, Leonor Senent, Jesús Martínez, Isidro Jarque, Miguel Salavert, Juan Córdoba, Lola Gómez, Shirley Weiss, Federico Moscardó, Javier de la Rubia, Luis Larrea, Miguel A. SanzGuillermo F. Sanz

Research output: Contribution to journalArticle

40 Scopus citations

Abstract

There is no information on the efficacy and safety of anticytomegalovirus (CMV) prophylaxis with intravenous ganciclovir or oral valganciclovir after unrelated cord-blood transplantation (UCBT). This issue was addressed in 151 adults (117 CMV-seropositive) undergoing UCBT at a single institution. The first 38 CMV-seropositive recipients were assigned to receive prophylactic ganciclovir, and the next 79 were given valganciclovir after engraftment. The cumulative incidence (CI) of CMV infection and disease was similar in patients receiving valganciclovir or ganciclovir (59% versus 55%, P = .59; and 9% versus 18%, P = .33, respectively). The toxicity profile and CI of nonrelapse mortality (CMV) and infection-related mortality did not differ between drugs. Patients receiving valganciclovir required fewer visits to the day hospital (P = .04). The CI of CMV infection and disease in 34 CMV-seronegative recipients was 12% and 6%, indicating that tight CMV monitoring is mandatory in this subset. The recipient's CMV serostatus, acute and extensive chronic graft-versus-host disease (aGVHD, cGVHD) were the main risk factors for CMV infection, and aGVHD for CMV disease. This study suggests that prophylaxis with oral valganciclovir is as safe and effective as intravenous ganciclovir for preventing CMV infection and disease after UCBT, but valganciclovir reduces the use of hospital resources.

Original languageEnglish (US)
Pages (from-to)730-740
Number of pages11
JournalBiology of Blood and Marrow Transplantation
Volume15
Issue number6
DOIs
StatePublished - Jun 1 2009

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Keywords

  • Cytomegalovirus
  • Ganciclovir
  • Prophylaxis
  • Umbilical cord blood transplantation
  • Valganciclovir

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Montesinos, P., Sanz, J., Cantero, S., Lorenzo, I., Martín, G., Saavedra, S., Palau, J., Romero, M., Montava, A., Senent, L., Martínez, J., Jarque, I., Salavert, M., Córdoba, J., Gómez, L., Weiss, S., Moscardó, F., de la Rubia, J., Larrea, L., ... Sanz, G. F. (2009). Incidence, Risk Factors, and Outcome of Cytomegalovirus Infection and Disease in Patients Receiving Prophylaxis with Oral Valganciclovir or Intravenous Ganciclovir after Umbilical Cord Blood Transplantation. Biology of Blood and Marrow Transplantation, 15(6), 730-740. https://doi.org/10.1016/j.bbmt.2009.03.002