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Pre-transplant ganciclovir and post transplant high-dose valacyclovir reduce CMV infections after alemtuzumab-based conditioning

Bone Marrow Transplantation volume 37, pages 307–310 (2006)Cite this article

Abstract

Alemtuzumab (Campath-1H)-based conditioning regimens are effective in preventing GVHD, but are associated with very high rates of cytomegalovirus (CMV) infection, a major limitation to their use. We evaluated 85 patients receiving conditioning with fludarabine 30 mg/m2/day (day −7 to day −3), alemtuzumab 20 mg/day (day −7 to day −3), and melphalan 140 mg/m2 on day −2. The initial patients received post transplant CMV prophylaxis with high-dose acyclovir. A very high incidence of CMV viremia was observed as has been commonly reported after alemtuzumab-based conditioning. Sixty-seven subsequent patients received pre-transplant ganciclovir and high-dose valacyclovir after engraftment. The cumulative incidence of CMV infection in the valacyclovir cohort was 29%. This compared favorably to the cumulative incidence of 53% in patients receiving only acyclovir (P=0.004) and to literature data. CMV prophylaxis with pre-transplant ganciclovir and high-dose valacyclovir after engraftment appears effective in preventing the excessive incidence of CMV infection after alemtuzumab-based conditioning regimens.

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Acknowledgements

Supported in part by a Grant from Berlex pharmaceuticals and by NCI Grant 1-R21 CA 101337-01.

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Authors and Affiliations

  1. Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA

    J Kline, W Stock, A Artz, E Rich, L Godley, T Zimmerman, R A Larson & K van Besien

  2. The Division of Medicine, University of Chicago, Chicago, IL, USA

    D A Pollyea

  3. The Section of Infectious Diseases, University of Chicago, Chicago, IL, USA

    K Pursell

  4. the Division of Pathology, University of Chicago, Chicago, IL, USA

    K Thompson

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  1. J Kline
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  2. D A Pollyea
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  4. A Artz
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  5. E Rich
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  6. L Godley
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  11. K van Besien
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Correspondence to K van Besien.

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Kline, J., Pollyea, D., Stock, W. et al. Pre-transplant ganciclovir and post transplant high-dose valacyclovir reduce CMV infections after alemtuzumab-based conditioning. Bone Marrow Transplant 37, 307–310 (2006). https://doi.org/10.1038/sj.bmt.1705249

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