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Use of Valacyclovir for the treatment of cytomegalovirus antigenemia after hematopoietic stem cell transplantation

BACKGROUND: Valacyclovir has been used for prophylaxis against cytomegalovirus (CMV) infection after hematopoietic stem cell transplantation (HSCT). We investigated the efficacy and safety of high-dose Valacyclovir as pre-emptive therapy in patients with CMV antigenemia after HSCT. METHODS: In a ret...

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Autores principales: Ong, Shin-Yeu, Truong, Ha-Thi-Thu, Diong, Colin Phipps, Linn, Yeh-Ching, Ho, Aloysius Yew-Leng, Goh, Yeow-Tee, Hwang, William Ying-Khee
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471913/
https://www.ncbi.nlm.nih.gov/pubmed/26090121
http://dx.doi.org/10.1186/s12878-015-0028-2
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author Ong, Shin-Yeu
Truong, Ha-Thi-Thu
Diong, Colin Phipps
Linn, Yeh-Ching
Ho, Aloysius Yew-Leng
Goh, Yeow-Tee
Hwang, William Ying-Khee
author_facet Ong, Shin-Yeu
Truong, Ha-Thi-Thu
Diong, Colin Phipps
Linn, Yeh-Ching
Ho, Aloysius Yew-Leng
Goh, Yeow-Tee
Hwang, William Ying-Khee
author_sort Ong, Shin-Yeu
collection PubMed
description BACKGROUND: Valacyclovir has been used for prophylaxis against cytomegalovirus (CMV) infection after hematopoietic stem cell transplantation (HSCT). We investigated the efficacy and safety of high-dose Valacyclovir as pre-emptive therapy in patients with CMV antigenemia after HSCT. METHODS: In a retrospective single center study of 61 patients, we compared the rates of viral clearance, recurrent antigenemia and adverse events in patients with pp65 CMV antigenemia who received high dose Valacyclovir (n = 15), Valganciclovir (n = 16), and Foscarnet (n = 30). RESULTS: Overall, 60/61 (98 %) of cases achieved CMV antigenemia clearance by day 28, and no patient developed CMV disease. After adjusting for age, sex, diagnosis, CMV serological status, donor type, CMV antigen level, graft-versus-host disease (GVHD) therapy, and conditioning regimen, there were no significant differences in the rates of viral clearance at day 14 in patients who received Valganciclovir (0.18, 95 % confidence interval (CI) 0.01 to 2.15, p = 0.17) and Foscarnet (OR 0.22, 95 % CI 0.03 to 2.40, p = 0.22), compared with Valacyclovir (assigned OR = 1.00). Recurrent antigenemia by day 180 after clearance of the initial CMV episode occurred in 34/61 (56 %) of patients. Using the multivariate model adjusting for the same covariates, there were also no significant differences in secondary episodes of CMV between treatment groups. With regards to adverse effect monitoring, Foscarnet led to significantly increased creatinine levels (P = 0.009), while Valganciclovir led to significant decrease in neutrophil counts (P = 0.012). CONCLUSION: High dose Valacyclovir is a potential alternative to Valganciclovir and Foscarnet in the stable post-HSCT patient who has cytopenia and is not keen for inpatient treatment of CMV antigenemia.
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spelling pubmed-44719132015-06-19 Use of Valacyclovir for the treatment of cytomegalovirus antigenemia after hematopoietic stem cell transplantation Ong, Shin-Yeu Truong, Ha-Thi-Thu Diong, Colin Phipps Linn, Yeh-Ching Ho, Aloysius Yew-Leng Goh, Yeow-Tee Hwang, William Ying-Khee BMC Hematol Research Article BACKGROUND: Valacyclovir has been used for prophylaxis against cytomegalovirus (CMV) infection after hematopoietic stem cell transplantation (HSCT). We investigated the efficacy and safety of high-dose Valacyclovir as pre-emptive therapy in patients with CMV antigenemia after HSCT. METHODS: In a retrospective single center study of 61 patients, we compared the rates of viral clearance, recurrent antigenemia and adverse events in patients with pp65 CMV antigenemia who received high dose Valacyclovir (n = 15), Valganciclovir (n = 16), and Foscarnet (n = 30). RESULTS: Overall, 60/61 (98 %) of cases achieved CMV antigenemia clearance by day 28, and no patient developed CMV disease. After adjusting for age, sex, diagnosis, CMV serological status, donor type, CMV antigen level, graft-versus-host disease (GVHD) therapy, and conditioning regimen, there were no significant differences in the rates of viral clearance at day 14 in patients who received Valganciclovir (0.18, 95 % confidence interval (CI) 0.01 to 2.15, p = 0.17) and Foscarnet (OR 0.22, 95 % CI 0.03 to 2.40, p = 0.22), compared with Valacyclovir (assigned OR = 1.00). Recurrent antigenemia by day 180 after clearance of the initial CMV episode occurred in 34/61 (56 %) of patients. Using the multivariate model adjusting for the same covariates, there were also no significant differences in secondary episodes of CMV between treatment groups. With regards to adverse effect monitoring, Foscarnet led to significantly increased creatinine levels (P = 0.009), while Valganciclovir led to significant decrease in neutrophil counts (P = 0.012). CONCLUSION: High dose Valacyclovir is a potential alternative to Valganciclovir and Foscarnet in the stable post-HSCT patient who has cytopenia and is not keen for inpatient treatment of CMV antigenemia. BioMed Central 2015-06-19 /pmc/articles/PMC4471913/ /pubmed/26090121 http://dx.doi.org/10.1186/s12878-015-0028-2 Text en © Ong et al. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Ong, Shin-Yeu
Truong, Ha-Thi-Thu
Diong, Colin Phipps
Linn, Yeh-Ching
Ho, Aloysius Yew-Leng
Goh, Yeow-Tee
Hwang, William Ying-Khee
Use of Valacyclovir for the treatment of cytomegalovirus antigenemia after hematopoietic stem cell transplantation
title Use of Valacyclovir for the treatment of cytomegalovirus antigenemia after hematopoietic stem cell transplantation
title_full Use of Valacyclovir for the treatment of cytomegalovirus antigenemia after hematopoietic stem cell transplantation
title_fullStr Use of Valacyclovir for the treatment of cytomegalovirus antigenemia after hematopoietic stem cell transplantation
title_full_unstemmed Use of Valacyclovir for the treatment of cytomegalovirus antigenemia after hematopoietic stem cell transplantation
title_short Use of Valacyclovir for the treatment of cytomegalovirus antigenemia after hematopoietic stem cell transplantation
title_sort use of valacyclovir for the treatment of cytomegalovirus antigenemia after hematopoietic stem cell transplantation
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471913/
https://www.ncbi.nlm.nih.gov/pubmed/26090121
http://dx.doi.org/10.1186/s12878-015-0028-2
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