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https://doi.org/10.1186/s12878-015-0028-2
Title: | Use of Valacyclovir for the treatment of cytomegalovirus antigenemia after hematopoietic stem cell transplantation | Authors: | Ong, S.-Y Truong, H.-T.-T Diong, C.P Linn, Y.-C Ho, A.Y.-L Goh, Y.-T Hwang, W.Y.-K |
Keywords: | aciclovir calcineurin inhibitor cotrimoxazole cytomegalovirus antigen pp65 foscarnet itraconazole posaconazole thymocyte antibody valaciclovir valganciclovir acute lymphoblastic leukemia acute myeloid leukemia adolescent adult age distribution aged Article blood toxicity controlled study creatinine blood level cytomegalovirus infection drug efficacy drug megadose drug monitoring drug safety female graft versus host reaction hematopoietic stem cell transplantation herpes zoster human human cell immunosuppressive treatment major clinical study male mycosis myelodysplastic syndrome nephrotoxicity neutropenic enterocolitis nonhodgkin lymphoma Pneumocystis pneumonia recurrent virus infection retrospective study risk benefit analysis treatment duration viral clearance virus load virus reactivation |
Issue Date: | 2015 | Citation: | Ong, S.-Y, Truong, H.-T.-T, Diong, C.P, Linn, Y.-C, Ho, A.Y.-L, Goh, Y.-T, Hwang, W.Y.-K (2015). Use of Valacyclovir for the treatment of cytomegalovirus antigenemia after hematopoietic stem cell transplantation. BMC Hematology 15 (1) : 8. ScholarBank@NUS Repository. https://doi.org/10.1186/s12878-015-0028-2 | Rights: | Attribution 4.0 International | Abstract: | 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. © 2015 Ong et al. | Source Title: | BMC Hematology | URI: | https://scholarbank.nus.edu.sg/handle/10635/180347 | ISSN: | 20521839 | DOI: | 10.1186/s12878-015-0028-2 | Rights: | Attribution 4.0 International |
Appears in Collections: | Elements Staff Publications |
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