3 WEEKS OF GANCICLOVIR FOR CYTOMEGALOVIRAEMIA AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION

Cytomegaloviraemia diagnosed by early antigen detection or conventiona l viral culture from blood occurred 7-71 days (median 41 days) after t ransplant in 25 of 38 consecutive patients undergoing bone marrow tran splantation (BMT) from HLA-identical siblings for haematological malig nancies where patient and/or donor were CMV-seropositive. Prophylactic ganciclovir, high-dose intravenous acyclovir or immunoglobulin were n ot administered. Viraemia was treated with a short 3-week course of ga nciclovir (10 mg/kg x 1 week, 5 mg/kg x 2 weeks). Clearance of viraemi a occurred 3-47 days (median 6 days) after starting anti-viral therapy in 20 patients (18 with ganciclovir, 2 with foscarnet), and before th erapy in 3 patients. The remaining 2 patients received inadequate anti -viral therapy for various reasons and died of CMV pneumonitis. There was no clinical evidence of CMV disease in the 13 patients who did not develop viraemia. One patient treated with ganciclovir before adequat e haematological recovery died of graft failure. A second episode of v iraemia occurred in four patients, and a third in one. We conclude tha t a short 3-week course of ganciclovir is adequate in most patients de veloping cytomegaloviraemia after allogeneic BMT. Treatment is not nec essary in all patients but some inadequately treated patients develop CMV disease. Ganciclovir is tolerated well but may cause severe myelos uppression if used prior to adequate marrow recovery.