¹Medizinische Klinik und Poliklinik, Abt II, Tübingen, Germany

²Abteilung Medizinische Virologie, Tübingen, Germany

³Kinderklinik, Tübingen, Germany

⁴Institut für Medizinische Biometrie, Universität Tübingen, Tübingen, Germany

Correspondence to: Dr H Einsele, Medizinische Klinik, Abt.II, Otfried-Müller Str. 10, D-72076 Tübingen, Germany

PCR-based preemptive therapy with ganciclovir has been shown to reduce the incidence of CMV disease after BMT. Failures of this treatment strategy are CMV disease and secondary non-viral infections. Eighty-six consecutive patients at high risk for CMV disease who received PCR-based preemptive therapy with ganciclovir were assessed for treatment failures and possible risk factors. Ganciclovir was initiated in 57 of 86 patients (66%). Only 28 of 86 (32%) patients received 4 or more weeks of ganciclovir. Recurrence of CMV infection after successful treatment was more frequent among recipients of a BMT from an unrelated compared to a sibling donor (P = 0.004). three (3.5%) patients developed non-fatal early onset cmv disease and seven of 68 (10.3 %) late onset cmv disease (>100 days post transplant). Risk factors for late onset CMV disease were cGVHD (P = 0.0017) and duration of prior antiviral therapy >4 weeks (P = 0.0073). The incidence of secondary non-viral infections was 28% with the duration of antiviral treatment being a significant risk factor for secondary bacterial (P = 0.0045) and invasive fungal infections (P = 0.006). Thus, PCR-based preemptive treatment with ganciclovir reduces early onset CMV disease, but the duration of antiviral therapy prior to day +100 is a significant risk factor for late onset CMV disease as well as secondary non-viral infections. Bone Marrow Transplantation (2000) 25, 757-763.

CMV; BMT; late onset disease; PCR; secondary infections