TY - JOUR
T1 - CMV management with specific immunoglobulins
T2 - A multicentric retrospective analysis on 92 allotransplanted patients
AU - Malagola, Michele
AU - Greco, Raffaella
AU - Santarone, Stella
AU - Natale, Annalisa
AU - Iori, Anna Paola
AU - Quatrocchi, Luisa
AU - Barbieri, Walter
AU - Bruzzese, Antonella
AU - Leotta, Salvatore
AU - Carotti, Alessandra
AU - Pierini, Antonio
AU - Bernardi, Simona
AU - Morello, Enrico
AU - Polverelli, Nicola
AU - Turra, Alessandro
AU - Cattina, Federica
AU - Gandolfi, Lisa
AU - Rambaldi, Benedetta
AU - Lorentino, Francesca
AU - Serio, Francesca
AU - Milone, Giuseppe
AU - Velardi, Andrea
AU - Foà, Robin
AU - Ciceri, Fabio
AU - Russo, Domenico
AU - Peccatori, Jacopo
PY - 2019/1/1
Y1 - 2019/1/1
N2 - CMV represents one of the most severe life-threatening complications of allogeneic stem cell transplantation (allo-SCT). Pre-emptive treatment is highly effective, but toxicity and repetitive reactivation of CMV represent a significant challenge in the clinical practice. The use of anti-CMV specific immunoglobulins (Megalotect) is controversial. We retrospectively collected data on 92 patients submitted to allo-SCT for hematological malignancies, in whom Megalotect was used either for prophylaxis (n=14) or with pre-emptive therapy, together with an anti-CMV specific drug (n=78). All the patients were considered at high-risk, due to the presence of at least one risk factor for CMV reactivation. The treatment was well tolerated, with no reported infusion reactions, nor other adverse events, none of the 14 cases treated with Megalotect as prophylaxis developed CMV reactivation. 51/78 (65%) patients who received Megalotect during pre-emptive treatment achieved complete clearance of CMV viremia, and 14/51 patients (29%) developed a breakthrough CMV infection. 7/78 patients (9%) developed CMV disease. The projected 1-year OS, 1-year TRM, and 1-year RR is 74%, 15%, and 19%, respectively. No differences were observed in terms of OS, TRM, and RR by comparing patients who achieved a complete response after treatment versus those who did not. These retrospective data suggest that Megalotect is safe and well-tolerated. When used as prophylaxis, no CMV reactivation was recorded. Further prospective trials are warranted to identify the best set of patients who can benefit from Megalotect alone or in addition to anti-CMV specific drugs.
AB - CMV represents one of the most severe life-threatening complications of allogeneic stem cell transplantation (allo-SCT). Pre-emptive treatment is highly effective, but toxicity and repetitive reactivation of CMV represent a significant challenge in the clinical practice. The use of anti-CMV specific immunoglobulins (Megalotect) is controversial. We retrospectively collected data on 92 patients submitted to allo-SCT for hematological malignancies, in whom Megalotect was used either for prophylaxis (n=14) or with pre-emptive therapy, together with an anti-CMV specific drug (n=78). All the patients were considered at high-risk, due to the presence of at least one risk factor for CMV reactivation. The treatment was well tolerated, with no reported infusion reactions, nor other adverse events, none of the 14 cases treated with Megalotect as prophylaxis developed CMV reactivation. 51/78 (65%) patients who received Megalotect during pre-emptive treatment achieved complete clearance of CMV viremia, and 14/51 patients (29%) developed a breakthrough CMV infection. 7/78 patients (9%) developed CMV disease. The projected 1-year OS, 1-year TRM, and 1-year RR is 74%, 15%, and 19%, respectively. No differences were observed in terms of OS, TRM, and RR by comparing patients who achieved a complete response after treatment versus those who did not. These retrospective data suggest that Megalotect is safe and well-tolerated. When used as prophylaxis, no CMV reactivation was recorded. Further prospective trials are warranted to identify the best set of patients who can benefit from Megalotect alone or in addition to anti-CMV specific drugs.
KW - CMV disease
KW - CMV infection
KW - Pre-emptive treatement
KW - Prophylaxis
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U2 - 10.4084/mjhid.2019.048
DO - 10.4084/mjhid.2019.048
M3 - Article
AN - SCOPUS:85072196012
VL - 11
JO - Mediterranean Journal of Hematology and Infectious Diseases
JF - Mediterranean Journal of Hematology and Infectious Diseases
SN - 2035-3006
IS - 1
M1 - e2019048
ER -