• Isabel Ruiz-Camps, Oscar Len, Rafael de la Cámara, Mercedes Gurguí, Rodrigo Martino, Isidro Jarque, Cristina Barrenetxea, Díaz de HerediaCristinaC, Montserrat Batlle, Montserrat Rovira, Julián de la Torre, Antonio Torres, Manuela Aguilar, Ildefonso Espigado, Pilar Martín-Dávila, German Bou, Nuria Borrell, Jose Maria Aguado, Albert Pahissa, and Spanish Network for Research on Infection in Transplantation (RESITRA/REIPI). Spain.
• Hospital Universitari Vall d'Hebron, Barcelona, Spain. iruiz@vhebron.net
• Antivir. Ther. (Lond.). 2011 Jan 1; 16 (7): 951-7.

BackgroundIn haematopoietic stem cell transplant (HSCT) recipients, cytomegalovirus (CMV) infection contributes significantly to morbidity and mortality in both the early and late post-transplant period. Ganciclovir (GCV) is the treatment of choice for CMV, but requires intravenous administration, a fact that complicates its long-term use. Oral valganciclovir (VGCV) and intravenous GCV were recently shown to have similar efficacy for pre-emptive CMV treatment in solid organ transplant recipients, but relatively limited data are available in HSCT recipients. The objectives of this study were to compare the efficacy of VGCV versus intravenous GCV or foscarnet (FOS) for pre-emptive therapy of active CMV infection in allogeneic HSCT and to determine the incidence of adverse effects and relapses.MethodsThis was a 2-year prospective, comparative cohort study in which 237 episodes of pre-emptive therapy for active CMV infection were collected in 166 allogeneic HSCT recipients out of 717 included in the Spanish Network for Research on Infection in Transplantation (RESITRA/REIPI) database. Intravenous GCV was the first-line treatment in 112 episodes, intravenous FOS in 38 episodes, and oral VGCV in 87 episodes.ResultsVGCV was used as pre-emptive therapy for active CMV infection in 87 episodes. Excluding episodes considered as relapse, VGCV was as successful (91.4% [74/81]) as GCV (83.7% [87/14]) or FOS (75.8% [25/33]). In the VGCV arm, 7 (8.6%) cases were considered treatment failures: 4 (4.9%) because of adverse events, 1 (1.2%) due to persistent viral activity and 2 (2.5%) based on clinical decision. There were also 6 (7.4%) cases of recurrent infection. No statistically significant differences were found when compared to GCV or FOS.ConclusionsIn allogeneic HSCT recipients, VGCV seemed effective and safe in the pre-emptive therapy of active CMV infection.

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