Valganciclovir for cytomegalovirus preemptive therapy in patients following allogeneic hematopoietic stem cell transplantation

Abstract

Objective and;To evaluate the clinical value of valganciclovir in preemptive treatment of cytomegalovirus (CMV) infection after allogeneic hematopoietic stem cell transplantation (allo-HSCT) by comparing the efficacy of the drug with other conventional antiviral drugs (ganciclovir or foscarnet sodium). Methods and;Clinical data of 139 patients who received allo-HSCT in our institute from December 2017 to April 2019 were collected and retrospectively analyzed. According to conditioning regimen and graft versus host disease (GVHD) prophylactic regimen on dosage of antithymocyte globulin (ATG), the patients were divided to ATG-free group (n=28), and low- (≤6 mg/kg, n=73) and high-dose ATG groups (>6 mg/kg, n=38). Real-time quantitative polymerase chain reaction (RQ-PCR) was performed to detect the peripheral blood level of CMV-DNA after transplantation. For the patients having CMV viremia (CMV-DNA >400 copies/mL), valganciclovir and ganciclovir or foscarnet sodium were employed for preemptive treatment. The incidence of CMV viremia, and clearance rate and median time of plasma CMV-DNA were compared among the different dose ATG group and conventional drug group. Results and;CMV viremia was observed in 52 patients, with an incidence of 37.4% (52/139). Within 100 d after transplantation, the incidence of CMV viremia was 14.3%, 34.2% and 50.0%, respectively, in the ATG-free group, low- and high-dose ATG groups (P=0.011). Among these 52 patients, the clearance rate of plasmic CMV-DNA was 100% in both valganciclovir group (n=20) and conventional antiviral group (n=32). However, the median time of CMV-DNA clearance was significantly shorter in the valganciclovir group than the conventional antiviral group (21 vs 31 d, P=0.022). In the high-dose ATG group, the median time of clearance of plasma CMV-DNA was significantly shorter in the valganciclovir group (6 cases) than the conventional antiviral group (13 cases)(7 vs 35 d, Pandlt;0.001). Conclusion and;Preemptive treatment with valganciclovir can effectively shorten the time and accelerate the clearance of plasma CMV-DNA in patients after allo-HSCT, especially in those patients receiving high-dose ATG before transplantation.

Keywords

• cytomegalovirus viremia
• allogeneic hematopoietic stem cell transplantation
• valganciclovir
• preemptive therapy
• antithymocyte globulin