Intensive strategy to prevent cytomegalovirus disease in seropositive umbilical cord blood transplant recipients.

Publication Type:

Journal Article

Source:

Blood, Volume 118, Issue 20, p.5689-96 (2011)

Keywords:

2011, Adolescent Adult, Antiviral Agents, Center-Authored Paper, Child, Clinical Research Division, Cohort Studies, Cord Blood Stem Cell Transplantation, Cytomegalovirus Infections, Female, Ganciclovir, Humans, Immunosuppressive Agents, Incidence, Male, Middle Aged, October 2011, Proportional Hazards Models, RECURRENCE, Research Trials Office Core Facility - Biostatistics Service, Risk Factors, Seroepidemiologic Studies, Shared Resources, Vaccine and Infectious Disease Division, Viral Load, Young Adult

Abstract:

Seropositive umbilical cord blood transplant (UCBT) recipients are at increased risk for CMV complications. To reduce CMV complications, we adopted an intensive strategy which consists of pre-transplant ganciclovir (5mg/kg IV daily from day -8 to day -2), post-transplant high-dose acyclovir (2 grams 3 times daily) and bi-weekly monitoring using a serum CMV PCR for preemptive therapy. Hazard rates and cumulative incidence of CMV complications along with days treated were compared in high-risk CMV seropositive UCBT recipients who received the intensive strategy and a historical cohort who received a standard strategy. Of 72 seropositive patients, 29 (40%) received standard prophylaxis and 43 (60%) the new intensive approach. The hazard rate for CMV reactivation was lower for patients receiving the intensive strategy (HR 0.27, 95% CI: 0.15-0.48; p<0.001), and led to fewer cases of CMV disease by 1 year (HR 0.11, 95% CI: 0.02-0.53; p=0.006). In patients who reactivated, the intensive strategy also led to fewer days on CMV-specific antiviral therapy (median 42% [IQR 21, 63] vs. 70% [IQR 54, 83], p<0.001). Use of an intensive CMV prevention strategy in high-risk CMV seropositive UCBT recipients results in a significant decrease in CMV reactivation and disease.