Ganciclovir in the Prevention of Cytomegalovirus Reactivation in Allogeneic Hematopoietic Stem Cell Transplantation: Non-Eliminative Reduction of Viral Load
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Abstract
Objective: Objective: Allogeneic hematopoietic stem cell transplantation (HCT) is used to treat various hematological disorders with a significant risk of treatment-related morbidity and mortality. During long immunosuppressed status, reactivation of cytomegalovirus (CMV) is a challenging complication with its diagnosis, treatment, and toxicity. In our study, we aimed to evaluate the effectiveness of ganciclovir to prophylaxis with valacyclovir in patients who have undergone allogeneic HCT.
Material and Methods: Data of 82 patients were analyzed in a retrospective manner. Patients were grouped as patients receiving valacyclovir alone or ganciclovir plus valacyclovir. CMV-DNA levels were monitored weekly. Reactivation and alterations of viral DNA levels were recorded and compared in both prophylaxis regimes.
Results: Mean age of patients was 44.85 years (19-69 years). The 31 patients were female (37,8%) and 51 were male (62,2%). All recipients were CMV seropositive before allogeneic HCT, and only 2 donors were CMV seronegative (2,4%). Forty-one of the patients received valacyclovir (50%), while 41 received ganciclovir plus valacyclovir (50%). Reactivation was not observed in 32 patients (39%). The 33 of the 41 patients receiving ganciclovir plus valacyclovir and 18 of the 41 patients on valacyclovir alone developed CMV reactivation. Although the inclusion of ganciclovir to valacyclovir was not related with decreased rates of CMV reactivation, the level of CMV DNAemia was relatively lower in patients on ganciclovir plus valacyclovir than in valacyclovir treatment alone.
Conclusion: Inclusion of ganciclovir to valacyclovir in allogeneic HCT patients did not decrease the rate of CMV reactivation, and did not shorten the duration but reduced the degree of CMV DNAemia
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Accepted 2022-07-22
Published 2022-07-28
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