GANCICLOVIR PROPHYLAXIS FOR CYTOMEGALOVIRUS-INFECTION IN PEDIATRIC ALLOGENEIC BONE-MARROW TRANSPLANT RECIPIENTS

Twenty-nine pediatric allogeneic bone marrow transplant (BMT) recipien ts, ages 2-17 years, were followed prospectively for cytomegalovirus ( CMV) infection, Patients at risk received ganciclovir (GCV) prophylact ically at a dose of 5 mg/kg/day i.v., 3 to 5 days per week, until day 100, Surveillance blood and urines were obtained weekly, Twelve patien ts developed CMV infection: one patient died with CMV interstitial pne umonitis on day 19 post-transplant prior to initiating GCV prophylaxis ; 10 patients developed CMV viremia (n = 9) or viruria (n = 1) between day 30 and day 95 (median day 50) while receiving GCV prophylaxis; an d one patient developed asymptomatic CMV viruria on day 130, 1 month a fter completing GCV prophylaxis, Patients with breakthrough infections on prophylaxis were treated with intensified GCV and i.v. immunoglobu lin. No patient developed visceral involvement, although five patients had recurrent viremia, Six of the seven long-term survivors continued to excrete CMV in the urine intermittently for 6 to 28 months post-tr ansplant, GCV was well tolerated with transient, mild neutropenia in f ive patients and thrombocytopenia in four patients, No extramedullary toxicity was encountered, GCV prophylaxis at a dose of 15-25 mg/kg/wee k is not adequate to prevent CMV reactivation in children receiving ma rrow transplants from unrelated donors and/or T cell-depleted grafts.