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Preemptive ganciclovir administration based solely on asymptomatic pulmonary cytomegalovirus infection in allogeneic bone marrow transplant recipients: long-term follow-up.

Publication ,  Journal Article
Zaia, JA; Schmidt, GM; Chao, NJ; Rizk, NW; Nademanee, AP; Niland, JC; Horak, DA; Lee, J; Gallez-Hawkins, G; Kusnierz-Glaz, CR
Published in: Biol Blood Marrow Transplant
December 1995

The use of ganciclovir at the time of cytomegalovirus (CMV) infection but before disease onset has been termed "preemptive" therapy. This preemptive ganciclovir administration has been shown to be an effective method for preventing severe CMV disease after allogeneic bone marrow transplantation (BMT), but the optimal method of CMV surveillance is not clear. The purpose of this study was to evaluate effectiveness, side effects, and long-term outcome of preemptive ganciclovir therapy in allogeneic BMT recipients when ganciclovir is prescribed solely on the basis of CMV detection in day +35 bronchoalveolar lavage (BAL). In a consecutive cohort of 202 HLA-matched recipients of sibling donor marrow transplantations, 163 received prospective BAL and were given preemptive ganciclovir if CMV-positive; 39 had disqualifying complications and were not eligible for BAL. Over the 36-month follow-up, CMV disease occurred in 21 (10%) of the 202 BMT recipients; there was one CMV-related death. In the 60 subjects (37% of the total 163) who received preemptive ganciclovir based on positive CMV-BAL, two (3%) developed CMV disease during the first 120 days post-BMT and two more developed late disease. Among the 103 BAL-negative subjects, CMV disease occurred in eight (8%) during the first 120 days and in three (3%) at > 120 days. Forty-three percent of all CMV disease occurred either before day +35 BAL (four cases) or at late times after BMT (five cases). The negative predictive value of BAL was 91%, allowing for the occurrence of 52% of all CMV disease in subjects considered CMV-BAL-negative. Nevertheless, using this treatment method, no significant differences in neutropenia rates or in 36-month survival were noted in the high-risk group having pulmonary CMV infection (compared with the group without pulmonary CMV). Thus, a strategy of preemptive ganciclovir based on a single BAL can reduce the complications caused by CMV; however, improved surveillance methods are necessary to eliminate all CMV disease.

Duke Scholars

Published In

Biol Blood Marrow Transplant

ISSN

1083-8791

Publication Date

December 1995

Volume

1

Issue

2

Start / End Page

88 / 93

Location

United States

Related Subject Headings

  • Lung
  • Immunology
  • Humans
  • Ganciclovir
  • Follow-Up Studies
  • Cytomegalovirus Infections
  • Cytomegalovirus
  • Bone Marrow Transplantation
  • Antiviral Agents
  • 1103 Clinical Sciences
 

Citation

APA
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ICMJE
MLA
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Zaia, J. A., Schmidt, G. M., Chao, N. J., Rizk, N. W., Nademanee, A. P., Niland, J. C., … Kusnierz-Glaz, C. R. (1995). Preemptive ganciclovir administration based solely on asymptomatic pulmonary cytomegalovirus infection in allogeneic bone marrow transplant recipients: long-term follow-up. Biol Blood Marrow Transplant, 1(2), 88–93.
Zaia, J. A., G. M. Schmidt, N. J. Chao, N. W. Rizk, A. P. Nademanee, J. C. Niland, D. A. Horak, J. Lee, G. Gallez-Hawkins, and C. R. Kusnierz-Glaz. “Preemptive ganciclovir administration based solely on asymptomatic pulmonary cytomegalovirus infection in allogeneic bone marrow transplant recipients: long-term follow-up.Biol Blood Marrow Transplant 1, no. 2 (December 1995): 88–93.
Zaia JA, Schmidt GM, Chao NJ, Rizk NW, Nademanee AP, Niland JC, et al. Preemptive ganciclovir administration based solely on asymptomatic pulmonary cytomegalovirus infection in allogeneic bone marrow transplant recipients: long-term follow-up. Biol Blood Marrow Transplant. 1995 Dec;1(2):88–93.
Zaia JA, Schmidt GM, Chao NJ, Rizk NW, Nademanee AP, Niland JC, Horak DA, Lee J, Gallez-Hawkins G, Kusnierz-Glaz CR. Preemptive ganciclovir administration based solely on asymptomatic pulmonary cytomegalovirus infection in allogeneic bone marrow transplant recipients: long-term follow-up. Biol Blood Marrow Transplant. 1995 Dec;1(2):88–93.
Journal cover image

Published In

Biol Blood Marrow Transplant

ISSN

1083-8791

Publication Date

December 1995

Volume

1

Issue

2

Start / End Page

88 / 93

Location

United States

Related Subject Headings

  • Lung
  • Immunology
  • Humans
  • Ganciclovir
  • Follow-Up Studies
  • Cytomegalovirus Infections
  • Cytomegalovirus
  • Bone Marrow Transplantation
  • Antiviral Agents
  • 1103 Clinical Sciences