CMV prophylaxis with foscarnet in allogeneic bone marrow transplant recipients at high risk of developing CMV infections

A. Bacigalupo, E. Tedone, M. T. Van Lint, G. Trespi, M. Lonngren, M. A. Sanna, F. Moro, F. Frassoni, D. Occhini, F. Gualandi, T. Lamparelli, O. Figari, F. Benvenuto, M. R. Raffo, G. Sogno, A. Isaza, G. B. Di Negro, R. Felletti, G. Hale, A. M. Marmont

Research output: Contribution to journalArticlepeer-review

Abstract

Eleven patients underwent bone marrow transplant (BMT) from an HLA-identical sibling following single dose total body irradiation (TBI), with in vivo and ex vivo T cell depletion (TCD). In spite of CMV prophylaxis with acyclovir and high-dose iv Ig, 10 of 11 patients developed CMV antigenemia, at a median interval from BMT of 34 days (range 16-72 days) and five died with CMV disease. Foscarnet was then given prophylactically in 11 additional TCD patients to test whether we could (1) prevent CMV reactivation, and (2) reduce transplant-related mortality. Foscarnet was given daily from days +10 to +15 (180 mg/kg/day), then thrice weekly (90 mg/kg/day) until day +100. Five patients developed CMV antigenemia at a median interval from BMT of 42 days (range 16-65 days); one progressed to CMV pneumonitis and died. The risk of developing CMV antigenemia within day 100 is currently 91% for the historical control group and 45% for the foscarnet group (p = 0.005). At diagnosis of CMV, the median number of CMV antigen-positive cells was 6.5 (range 1-13) vs 1 (range 1-5) in acyclovir vs foscarnet patients (p = 0.02) and the median highest number of CMV antigen-positive cells was 7 (range 3-110) vs 1 (range 1-12), respectively, (p = 0.03). The actuarial 1 year transplant-related mortality (TRM) is 49% and 13% in the two groups(p = 0.08). This study suggests that foscarnet prophylaxis starting on day +10 post-BMT may be helpful in reducing the risk of CMV disease and early mortality following TCD BMT.

Original languageEnglish
Pages (from-to)783-788
Number of pages6
JournalBone Marrow Transplantation
Volume13
Issue number6
Publication statusPublished - 1994

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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