Journal
BONE MARROW TRANSPLANTATION
Volume 37, Issue 3, Pages 307-310Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/sj.bmt.1705249
Keywords
allogeneic transplant; CMV; valacyclovir; T-cell depletion; alemtuzumab
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Funding
- NCI NIH HHS [1-R21 CA 101337-01] Funding Source: Medline
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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/m(2)/day ( day - 7 to day - 3), alemtuzumab 20 mg/day ( day - 7 to day - 3), and melphalan 140 mg/m(2) 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 pretransplant 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.
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