Ganciclovir for the treatment of cytomegalovirus gastroenteritis in bone marrow transplant patients: a randomized, placebo-controlled trial

Article Abstract:

Cytomegalovirus infection is common among immunosuppressed patients, particularly patients with AIDS and those who have received bone marrow transplants. The infection may be completely asymptomatic and detectable only by virus culture, or it may involve the aggressive invasion of the virus into liver, lungs, eyes, or the gastrointestinal tract. While cytomegalovirus pneumonia is the most common infectious cause of death among bone marrow recipients, the virus is sometimes overlooked as a major cause of gastrointestinal infection resulting in anorexia, nausea, vomiting, and diarrhea, often serious enough to require hospitalization. Ganciclovir has been shown to be effective against cytomegalovirus replication both in tissue culture and in patients. However, clinical trials using ganciclovir to treat cytomegalovirus pneumonia in bone marrow transplant recipients did not improve survival. To determine if ganciclovir may be useful in the treatment of gastroenteritis resulting from cytomegalovirus in bone marrow transplant recipients, a randomized study was conducted with 18 patients receiving ganciclovir, and 19 control patients receiving a placebo (inactive agent). When throat, urine, and blood samples from the subjects were cultured for cytomegalovirus, the recovery of virus was significantly reduced among the patients receiving the anti-viral drug. The clinical course of the illness was not changed by ganciclovir, however, and the symptomatic improvement was the same in both groups. It should be emphasized that the absence of a clinically beneficial effect of ganciclovir on these patients may not be generalized to other patient groups. Bone marrow transplant recipients tend to acquire cytomegalovirus infection in their upper gastrointestinal tract, in contrast with AIDS patients, where gastrointestinal cytomegalovirus infection is more likely in the lower tract. Therefore, the results obtained in the study of bone marrow recipients may not apply to the AIDS patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Gastroenteritis

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Ganciclovir prophylaxis to prevent cytomegalovirus disease after allogeneic marrow transplant

Article Abstract:

The drug gancyclovir appears to suppress cytomegalovirus (CMV) infections and disease in patients who undergo bone marrow transplants. CMV disease affects many patients who undergo marrow transplants, and patients with CMV interstitial pneumonia have a death rate of between 30% and 55%. Of 64 patients who were seropositive for CMV before marrow transplantation, 33 received ganciclovir at the time of transplant and 31 received a placebo, or inactive substance. Among the patients who took placebo, 14 (45%) developed CMV infection compared with only one (3%) who took ganciclovir. Nine patients (29%) who took placebo developed CMV disease compared with none who took ganciclovir. However, neutropenia - a decrease in the number of white blood cells - occurred in 30% of patients taking ganciclovir but in none taking placebo. There were no significant differences in survival rates between the two groups either 100 or 180 days after the transplant.

Prevention, Physiological aspects, Neutropenia

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Veno-occlusive disease of the liver and multiorgan failure after bone marrow transplantation: a cohort study of 355 patients

Article Abstract:

Different factors may increase the risk of developing severe veno-occlusive disease (VOD) of the liver in patients who have undergone a bone marrow transplant. VOD is a liver disease characterized by damage to the blood vessels in the liver. Among 355 patients who underwent a bone marrow transplant, 190 (54%) developed VOD of the liver. Fifty-four patients developed a severe form of VOD, and 136 developed a mild or moderate form of the disease. The risk of severe VOD was higher in patients with elevated blood levels of transaminase before transplantation or those who underwent high dose cytoreductive therapy than in other patients. Patients treated with vancomycin during cytoreductive therapy or with acyclovir before transplantation were also more likely to develop severe VOD than other patients. Other risk factors for severe VOD included a mismatched or unrelated bone marrow donor or radiation therapy to the abdominal area.

Causes of, Liver diseases

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