What is the optimal dosage of valganciclovir as preemptive therapy for CMV infection in allogeneic hematopoietic SCT?

Candoni, Anna; Simeone, Ester; Tiribelli, Mario; Pipan, Corrado; Fanin, Renato

doi:10.1038/bmt.2008.98

Cited by 9 publications

(16 citation statements)

References 6 publications

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“…Overall, 9 out of 34 patients (26%) showed reversible grade I–II anemia, 4/34 patients (11%) showed reversible grade III–IV anemia, 1/34 patients (3%) showed reversible grade I–II neutropenia, 10/34 patients (29%) showed reversible grade III–IV neutropenia, 2/34 patients (5%) showed reversible grade I–II thrombocytopenia and 5/34 patients (14%) showed reversible grade III–IV thrombocytopenia according to NCI criteria. The toxicity rate in our cohort of patients was comparable to that reported in a previous study [11]. Toxicity rates for each group of treatment are represented in table 5.…”

Section: Resultssupporting

confidence: 75%

“…This study evidenced the efficacy and safety of low-dose preemptive valganciclovir therapy for CMV infection after allogeneic SCT. With the limitation of a nonrandomized study, in our series of patients a lower dose of valganciclovir (900 mg/day) had an efficacy comparable to the standard dose (1,800 mg/day) in agreement with other available observational data [11,19,20]. …”

Section: Discussionsupporting

confidence: 75%

“…The efficacy of valganciclovir has been reported in solid organ transplant recipients, as well as in immunocompromised patients, in particular in patients with HIV-related CMV retinitis [1,2,3,4,5,6]. A few trials have been conducted on the use of valganciclovir in allogeneic stem cell recipients [7,8,9,10,11,12,13,14] (table 1), but the optimal dosage of valganciclovir in these patients remains to be defined. …”

Section: Introductionmentioning

confidence: 99%

“…Candoni et al [11 ]suggested that clearance of CMV antigenemia was achieved with comparable efficiency in allogeneic hematopoietic SCT recipients treated with 900 and 1,800 mg/day of oral valganciclovir.…”

Section: Introductionmentioning

confidence: 99%

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Low-Dose Valganciclovir as Preemptive Therapy for Cytomegalovirus Infection Occurring in Allogeneic Stem Cell Transplant Recipients

et al. 2010

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Few data are available to date on the dose of oral valganciclovir as cytomegalovirus (CMV) preemptive therapy in stem cell transplantation patients. This study aimed to evaluate the efficacy and safety of low-dose valganciclovir (900 mg/day) as preemptive treatment in allotransplanted recipients. Valganciclovir was used in 34 patients who underwent allogeneic stem cell transplantation for hematological malignancies at the dose of 900 mg oral administration/day (12 patients, group 1) or 1,800 mg oral administration/day (22 patients, group 2). Thirty-two out of 34 patients (94%) obtained negativization of polymerase chain reaction for CMV at a median of 12.5 days from the beginning of valganciclovir administration (10/12 patients of group 1, 22/22 patients of group 2). We conclude that oral administration of valganciclovir can induce clearance of CMV viral load in about 2 weeks; moreover, lower-dose oral valganciclovir (900 mg/day) has a comparable efficacy to the proposed standard dose (1,800 mg/day).

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Section: Resultssupporting

confidence: 75%

Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Low-Dose Valganciclovir as Preemptive Therapy for Cytomegalovirus Infection Occurring in Allogeneic Stem Cell Transplant Recipients

et al. 2010

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“…VGC and IV-GCV have similar efficacy in the treatment of CMV retinitis in HIV-infected patients and in preemptive CMV treatment in solid organ (heart, renal, and renal-pancreas) transplant patients [15][16][17][18][19]. Recently, several studies have shown the efficacy of VGC for preemptive therapy in allogeneic HSCT patients [20][21][22][23]. We evaluated the safety and efficacy of oral VGC as preemptive therapy for CMV reactivation in ten allogeneic HSCT patients.…”

Section: Introductionmentioning

confidence: 99%

Oral valganciclovir as preemptive therapy is effective for cytomegalovirus infection in allogeneic hematopoietic stem cell transplant recipients

et al. 2009

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Between March 2007 and January 2008, the safety and efficacy of oral valganciclovir (VGC) preemptive therapy for cytomegalovirus (CMV) infection was evaluated in ten consecutive patients who received allogeneic hematopoietic stem cell transplantation (HSCT). Patients were screened once or twice per week after engraftment using CMV pp65 antigenemia assay. When more than 2 CMV antigen-positive cells per 50,000 leukocytes were detected, preemptive therapy with oral VGC was initiated at a dose of 900 mg twice daily for 3 weeks. Nine patients (90%) completed the 3-week VGC treatment except for one patient who developed febrile neutropenia. There was no other significant toxicity. CMV antigen-positive cells were rapidly decreased in all nine patients and became undetectable by the end of the VGC treatment. None of the patients developed CMV disease. CMV infection relapsed in four of the ten patients (40%) after the VGC treatment. These observations suggest that preemptive therapy with VGC is effective for preventing CMV disease in allogeneic HSCT patients. Further studies with a large number of patients will be necessary to determine the optimal initial- and maintenance-dose of VGC.

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Cytomegalovirus infection/disease after hematopoietic stem cell transplantation

Mori

Kato

2010

Int J Hematol

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Cytomegalovirus (CMV) disease has historically been a main cause of death after allogeneic hematopoietic stem cell transplantation (HSCT). Since the introduction of prophylactic or preemptive therapy against CMV, the incidence of CMV disease has been successfully reduced. However, breakthrough CMV disease, particularly CMV gastrointestinal disease, remains one of the major infectious complications. Administration of an antiviral agent, ganciclovir, is often associated with myelotoxicity in HSCT recipients, and delayed immune reconstitution against CMV. Delayed immune reconstitution is a possible cause of the increasing incidence of late (more than 3 months after transplant) CMV disease after HSCT in this era of preemptive therapy. Foscarnet and valganciclovir are the available alternatives to intravenous ganciclovir. Foscarnet is not myelotoxic and has a toxicity profile different from ganciclovir. Valganciclovir, a prodrug of ganciclovir, has a higher bioavailability than oral ganciclovir and could be of clinical use, particularly in the outpatient setting or for patients requiring long-term antiviral therapy. Recent technological developments have enabled the visualization and isolation of CMV-specific T cells. Using these techniques, an individualized approach could be conducted based on each patient's immune reconstitution against CMV. In this review, we summarize the recent progress and current knowledge of CMV infection and disease after allogeneic HSCT.

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What is the optimal dosage of valganciclovir as preemptive therapy for CMV infection in allogeneic hematopoietic SCT?

Cited by 9 publications

References 6 publications

Low-Dose Valganciclovir as Preemptive Therapy for Cytomegalovirus Infection Occurring in Allogeneic Stem Cell Transplant Recipients

Low-Dose Valganciclovir as Preemptive Therapy for Cytomegalovirus Infection Occurring in Allogeneic Stem Cell Transplant Recipients

Oral valganciclovir as preemptive therapy is effective for cytomegalovirus infection in allogeneic hematopoietic stem cell transplant recipients

Cytomegalovirus infection/disease after hematopoietic stem cell transplantation

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