Please use this identifier to cite or link to this item: 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
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