FOSCARNET FOR PREVENTION OF CYTOMEGALOVIRUS-INFECTION IN ALLOGENEIC MARROW TRANSPLANT RECIPIENTS UNABLE TO RECEIVE GANCICLOVIR

Cytomegalovirus (CMV) disease can be prevented by administration of ga nciclovir prophylactically posttransplant, However, up to 30% of patie nts discontinue use of ganciclovir as a result of profound neutropenia and may subsequently develop CMV infections while unprotected, To pre vent reactivation of CMV, we administered foscarnet to 39 adults unabl e to receive ganciclovir due to delayed engraftment or ganciclovir-ind uced neutropenia, Twenty-four (62%) of the patients had received T cel l-depleted marrow transplants, Foscarnet sodium 60 mg/kg i.v. daily wa s continued until the neutropenia resolved, at which time ganciclovir was resumed, CMV prophylaxis commenced at a median of 28 days followin g transplantation. Median time to initiation of foscarnet was day 60 p ost-transplant, and the median duration of treatment was 22 days, Fosc arnet was well-tolerated. Six (15%) patients had CMV detected while re ceiving prophylaxis, and CMV-related mortality was 5%, Foscarnet is a safe and effective agent for prevention of CMV disease in allogeneic t ransplant recipients unable to receive ganciclovir.