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Bone Marrow Transplantation (2006) 37, 851856
& 2006 Nature Publishing Group All rights reserved 0268-3369/06 $30.00www.nature.com/bmtORIGINAL ARTICLEValganciclovir is safe and effective as pre-emptive therapy for CMV
infection in allogeneic hematopoietic stem cell transplantationE Ayala1, J Greene1, R Sandin1, J Perkins1, T Field1, C Tate1, KK Fields2 and S Goldstein31H Lee Moffitt Cancer Center, Tampa, FL, USA; 2University of Texas at San Antonio, San Antonio, TX, USA and 3University of
Pennsylvania, Philadelphia, PA, USADespite signicant advances in prevention and therapy,
cytomegalovirus (CMV) infection continues to be an
important cause of morbidity and mortality in the
hematopoietic stem cell transplant (HSCT) recipient.
The standard drug for pre-emptive therapy is intravenous
ganciclovir (GCV). Valganciclovir (VGC), the oral prodrug of GCV, has excellent bioavailability and is ideal for
oral therapy. Since March 2002, VGC was adopted in our
center for outpatient pre-emptive therapy in all patients
undergoing allogeneic HSCT. Fifty-two allogeneic HSCT
recipients were followed weekly via Digene hybrid capture
assays. Patients with a positive assay were treated with
VGC 900 mg p.o. b.i.d. 14 days followed by 900 mg p.o.
QDuntil at least 7 days after a negative test. Eighteen
patients (14 sib, four MUD) had 30 episodes of CMV
DNA detection treated with oral VGC. Median duration
of therapy was 21 days (range 1021 days). The rate of
response was 93% (28/30) as conrmed by a negative
assay within 14 days. No signicant toxicity was
encountered. Two patients failed oral VGC. One case of
CMV enteritis was diagnosed in a patient with acute
GVHD. Pre-emptive therapy of CMV infection with oral
VGC is safe and effective in allogeneic HSCT recipients.
Bone Marrow Transplantation (2006) 37, 851856.
doi:10.1038/sj.bmt.1705341; published online 13 March
2006Keywords: valganciclovir; pre-emptive; CMV infection;
allogeneic BMTIntroductionDespite signicant advances in prevention and treatment,
cytomegalovirus (CMV) infection continues to be an
important cause of morbidity and mortality in the
allogeneic hematopoietic stem cell transplantation (HSCT)
recipient.13 Improvements in management have reduced
the incidence of CMV disease from 20 to 30% in early
transplantation series to 510% today.3,4The use of alternative donors, T-cell depletion, nonmyeloablative conditioning regimens, and cord blood
transplantation has generated new populations of patients
at high risk for CMV reactivation and CMV disease.3,59
Similarly, the increasing number of patients treated with
corticosteroid-containing regimens for graft-versus-host