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Post-Transplant Events

Oral valganciclovir as pre-emptive therapy has similar efficacy on cytomegalovirus DNA load reduction as intravenous ganciclovir in allogeneic stem cell transplantation recipients

Bone Marrow Transplantation volume 37, pages 693–698 (2006)Cite this article

Abstract

The efficacy and safety of oral valganciclovir was compared to ganciclovir i.v. in pre-emptive treatment of cytomegalovirus (CMV) in T-cell-depleted allogeneic stem cell transplant (allo-SCT) recipients. A therapeutic guideline was developed to allow the safe application of valganciclovir in allo-SCT recipients requiring CMV therapy. In total, 107 consecutive transplant recipients were evaluated. Cytomegalovirus DNA load in plasma was monitored longitudinally; details on antiviral therapy and treatment responses were analyzed retrospectively. Fifty-seven CMV treatment episodes were recorded in 34 patients: 20 with valganciclovir (900 mg twice-daily) and 37 with ganciclovir (5 mg/kg twice-daily). Median CMV DNA load reduction was 0.079 and 0.069 log10 copies/ml/day in the ganciclovir and valganciclovir group, respectively. Good response on CMV DNA load (reduction below 3.0 log10 copies/ml) was observed in 75.7% of ganciclovir and 80.0% of valganciclovir treatment episodes. Severe adverse effects were not observed and CMV-related disease did not occur. However, the percentage of patients receiving erythrocyte transfusion was higher in the group of patients receiving ganciclovir as compared to valganciclovir (41 versus 20%, P=0.116). In conclusion, pre-emptive treatment with valganciclovir and ganciclovir, led to similar reduction of CMV DNA load. Oral valganciclovir is an attractive and safe alternative for pre-emptive CMV treatment in T-cell-depleted allo-SCT recipients.

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Acknowledgements

There was no financial support and no conflicts of interest are reported.

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Author notes

  1. P L J van der Heiden and J S Kalpoe: Both authors contributed equally to this paper.

Authors and Affiliations

  1. Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands

    P L J van der Heiden, R M Barge & R Willemze

  2. Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands

    J S Kalpoe & A C M Kroes

  3. Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands

    E F Schippers

Authors
  1. P L J van der Heiden
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  2. J S Kalpoe
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  3. R M Barge
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  4. R Willemze
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  5. A C M Kroes
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  6. E F Schippers
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Correspondence to E F Schippers.

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van der Heiden, P., Kalpoe, J., Barge, R. et al. Oral valganciclovir as pre-emptive therapy has similar efficacy on cytomegalovirus DNA load reduction as intravenous ganciclovir in allogeneic stem cell transplantation recipients. Bone Marrow Transplant 37, 693–698 (2006). https://doi.org/10.1038/sj.bmt.1705311

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