Effective CMV prophylaxis with high‐dose valaciclovir in allogeneic hematopoietic stem‐cell recipients at a high risk of CMV infection
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Le résumé fourni par la source
BACKGROUND: Cytomegalovirus (CMV) infection increases mortality and morbidity following allogeneic hematopoietic stem-cell transplantation (alloHSCT). Universal antiviral prophylaxis with letermovir is effective but unsubsidized in Australia. Valaciclovir demonstrates anti-CMV activity in high doses, but few current real-world studies explore its use as primary prophylaxis in high-risk patients post-alloHSCT. METHODS: We performed a retrospective analysis of alloHSCT recipients at high risk of clinically significant CMV infection (cs-CMVi), defined as a plasma CMV DNA viral load of >400 IU/ml requiring preemptive therapy, or CMV disease. High-risk recipients were CMV seropositive and underwent T-cell depleted, haploidentical or umbilical cord stem-cell transplants. Consecutive patients transplanted from July 2018 to January 2020, treated with valaciclovir 2 g TDS from day +7 to +100 (HD-VALA), were compared to a historical cohort (July 2017-June 2018) who only received preemptive CMV therapy, and standard valaciclovir (SD-VALA) for varicella/herpes prophylaxis. We compared incidence of and time to cs-CMVi. RESULTS: In the SD-VALA cohort (n = 27, median CMV follow-up duration 259 days), 23/27 (85%) developed cs-CMVi at a median of 39 days. For the HD-VALA cohort (n = 35, median CMV follow-up duration 216 days), 19/35 (54%) developed cs-CMVi, at a median of 68 days. Time to cs-CMVi was significantly longer in HD-VALA cohort (p < .0001). On multivariate analysis, HD VALA reduced the risk of cs-CMVi (HR 0.32, p = .0005). CONCLUSIONS: In alloHSCT recipients at high risk for cs-CMVi, HD-VALA resulted in lower cumulative reactivation, and delayed reactivation, reducing requirement for preemptive CMV therapy in the early post-engraftment period.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Effective CMV prophylaxis with high‐dose valaciclovir in allogeneic hematopoietic stem‐cell recipients at a high risk of CMV infection
- Date Crossref
- 01/12/2022
- Éditeur
- Wiley
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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The Royal Melbourne Hospital Department of Infectious Diseases pays non établi dans la noticeOrganisme public
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Peter MacCallum Cancer Centre pays non établi dans la noticeÉtablissement de santé
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The University of Melbourne Sir Peter MacCallum Department of Oncology pays non établi dans la noticeUniversité ou école supérieure
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Department of Clinical Haematology and Bone Marrow Transplantation pays non établi dans la noticeÉtablissement de santé
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Department of Infectious Diseases Royal Melbourne Hospital Parkville Australia pays non établi dans la noticeÉtablissement de santé
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National Centre for Infections in Cancer Parkville Australia pays non établi dans la noticeInstitution
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Sir Peter MacCallum Department of Oncology University of Melbourne Melbourne Australia pays non établi dans la noticeUniversité ou école supérieure
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Pharmacy Department Royal Melbourne Hospital Parkville Victoria Australia pays non établi dans la noticeÉtablissement de santé
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Department of Medicine University of Melbourne Melbourne Australia pays non établi dans la noticeUniversité ou école supérieure
Department of Infectious Diseases — The Royal Melbourne Hospital, Peter MacCallum Cancer Centre et Sir Peter MacCallum Department of Oncology — The University of Melbourne, avec 6 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.