Pre-transplant ganciclovir and post transplant high-dose valacyclovir reduce CMV infections after alemtuzumab-based conditioning

• Published in: Bone marrow transplantation (Basingstoke) Vol. 37; no. 3; pp. 307 - 310
• Main Authors: KLINE, J, POLLYEA, D. A, VAN BESIEN, K, STOCK, W, ARTZ, A, RICH, E, GODLEY, L, ZIMMERMAN, T, THOMPSON, K, PURSELL, K, LARSON, R. A
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01-02-2006
• Subjects: Acyclovir; Acyclovir - administration & dosage; Acyclovir - analogs & derivatives; Adolescent; Adult; Aged; Alemtuzumab; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal, Humanized; Antibodies, Neoplasm - administration & dosage; Antineoplastic Agents - administration & dosage; Antiviral agents; Antiviral Agents - administration & dosage; Biological and medical sciences; Bone Marrow Transplantation - adverse effects; Bone marrow, stem cells transplantation. Graft versus host reaction; Conditioning; Cytomegalovirus; Cytomegalovirus infections; Cytomegalovirus Infections - etiology; Cytomegalovirus Infections - prevention & control; Disease prevention; Dosage and administration; Drug therapy; Female; Fludarabine; Ganciclovir; Ganciclovir - administration & dosage; Graft-versus-host reaction; Hematologic Neoplasms - complications; Hematologic Neoplasms - therapy; Humans; Incidence; Infections; Male; Medical sciences; Melphalan; Middle Aged; Monoclonal antibodies; Prophylaxis; Risk factors; Stem cell transplantation; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation Conditioning; Transplantation, Homologous; Valacyclovir; Valine - administration & dosage; Valine - analogs & derivatives; Viremia; United States; Acyclic nucleoside; Purine nucleoside; Stem cell; Hematopoietic cell; Homograft; Valaciclovir; allogeneic transplant; Monoclonal antibody; Betaherpesvirinae; Ganciclovir; T-Lymphocyte; Nucleoside analog; Antiviral; Conditioning; High dose; Cytomegalovirus; Hematology; Herpesviridae; T-cell depletion; Alemtuzumab; Prodrug; CMV; Infection; Virus; Immunomodulator; Depletion; Viral disease; valacyclovir
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705249

Alemtuzumab (Campath-1H)-based conditioning regimens are effective in preventing GVHD, but are associated with very high rates of cytomegalovirus (CMV) infection, a major limitation to their use. We evaluated 85 patients receiving conditioning with fludarabine 30 mg/m2/day (day -7 to day -3), alemtuzumab 20 mg/day (day -7 to day -3), and melphalan 140 mg/m2 on day -2. The initial patients received post transplant CMV prophylaxis with high-dose acyclovir. A very high incidence of CMV viremia was observed as has been commonly reported after alemtuzumab-based conditioning. Sixty-seven subsequent patients received pre-transplant ganciclovir and high-dose valacyclovir after engraftment. The cumulative incidence of CMV infection in the valacyclovir cohort was 29%. This compared favorably to the cumulative incidence of 53% in patients receiving only acyclovir (P = 0.004) and to literature data. CMV prophylaxis with pre-transplant ganciclovir and high-dose valacyclovir after engraftment appears effective in preventing the excessive incidence of CMV infection after alemtuzumab-based conditioning regimens.