Early treatment with ganciclovir to prevent cytomegalovirus disease after allogenic bone marrow transplantation

Article Abstract:

Bone marrow transplantation is being used for the treatment of an increasing number of disorders, but recipients of bone marrow transplantation must accept great risks for this potentially life-saving procedure. Among the greater risks faced by bone marrow transplant recipients is infection with cytomegalovirus (CMV). Infection with this virus is common, but poses little threat to people with healthy immune systems. However, for patients who are immunocompromised for any reason, including bone marrow transplantation, CMV infection is a major cause of illness and death. The greatest threats are CMV pneumonia and CMV gastrointestinal disease. However, these conditions do not generally appear without some warning. Prior to the development of actual disease symptoms, virus may be recovered from samples of urine or blood, or from throat swabs. A study was undertaken to determine if prophylactic treatment given to patients developing early signs of infection could reduce the risk of more serious disease. A total of 72 bone marrow transplant recipients were randomly assigned to receive treatment with the antiviral drug ganciclovir or placebo. Treatment continued for the first 100 days after transplantation. Cytomegalovirus disease, confirmed by biopsy, developed in one of the 37 patients randomly assigned to receive ganciclovir. In contrast, 15 of the 35 patients receiving placebo developed CMV disease. Neutropenia, a reduction in the number of neutrophils, a type of white blood cell, was the major side effect observed in the ganciclovir-treated patients. Neutropenia necessitated the discontinuation of treatment of 11 patients receiving ganciclovir and one patient receiving placebo; subsequently, neutrophil counts returned to normal levels. The freedom from CMV disease among the patients taking ganciclovir was reflected by their overall survival. Only one of the ganciclovir patients died during the 180 days following bone marrow transplantation; the death was due to recurrent leukemia. Six patients in the placebo-treated group died as a result of cytomegalovirus disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Immunodeficiency

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A randomized, controlled trial of prophylactic ganciclovir for cytomegalovirus pulmonary infection in recipients of allogeneic bone marrow transplants

Article Abstract:

Infection with cytomegalovirus (CMV) resulting in interstitial pneumonia is the most common cause of death following bone marrow transplant. A retrospective study including 525 bone marrow recipients, followed over a 10-year period, showed that 17 percent of these patients developed CMV pneumonia and that 85 percent of those with CMV pneumonia died. Previous studies have reported improved rates of survival in transplant patients with CMV infection following treatment with a combination of immune globulin and ganciclovir. This indicates that it may be possible to prevent CMV pneumonia in transplant patients. In order to determine if CMV pneumonia can be prevented, 104 patients who underwent bone marrow transplants were studied. None of the patients had symptoms of pneumonia 35 days after the transplant. However, when samples of lung fluid (obtained by bronchoalveolar lavage, ''washing'' of the lungs) were tested in culture, it was found that 40 of the patients had infection with CMV. Twenty of these patients were randomly selected to receive ganciclovir five times a week until day 120 following transplant, and 20 were untreated. Of those receiving ganciclovir, only five percent developed CMV pneumonia or died prior to day 120. Most of the patients had few or no toxic side effects from the treatments. Seventy percent of the patients who did not receive ganciclovir developed CMV pneumonia or died by day 120. Twenty-two percent of the patients who tested negative for CMV infection on day 35 later developed CMV pneumonia. The best predictors for CMV pneumonia were positive lung and blood cultures for CMV infection on day 35 after transplant. It is concluded that ganciclovir is effective in preventing pneumonia in patients who have CMV infection following bone marrow transplant. (Consumer Summary produced by Reliance Medical Information, Inc.)

Development and progression, Viral pneumonia

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Oral ganciclovir for patients with cytomegalovirus retinitis treated with a ganciclovir implant

Article Abstract:

AIDS patients who receive an intraocular ganciclovir implant to treat cytomegalovirus retinitis should also take oral ganciclovir. Cytomegalovirus retinitis is a viral infection of the retina. Researchers randomly assigned 377 AIDS patients with cytomegalovirus retinitis in one eye to receive one of three treatments: an intraocular ganciclovir implant plus oral ganciclovir, an intraocular implant plus an oral placebo, or intravenous ganciclovir with no implant. Patients who received the implant plus oral ganciclovir delayed the progression of retinitis and also reduced the risk of cytomegalovirus infection in other parts of the body.

Retinal diseases

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