PROPHYLACTIC GANCICLOVIR IS MORE EFFECTIVE IN HLA-IDENTICAL FAMILY MEMBER MARROW TRANSPLANT RECIPIENTS THAN IN MORE HEAVILY IMMUNE-SUPPRESSED HLA-IDENTICAL UNRELATED DONOR MARROW TRANSPLANT RECIPIENTS

A multi-centre Australasian study of the efficacy of prophylactic ganc iclovir in 88 recipients of marrow allografts at high risk for post-tr ansplant cytomegalovirus (CMV) disease was conducted. The actuarial in cidence of CMV disease was 10% in 74 recipients of HLA-identical famil y member transplants given ganciclovir but was 33% in 14 recipients of HLA-identical unrelated donor transplants given more immune-suppressi on pre- and post-transplant (P = 0.006), CMV disease developed in 4 of the 14 recipients of HLA-identical unrelated donor transplants at a m edian of 59 days post-transplant and was associated with concurrent gr aft-versus-host disease (GVHD) in 2 of the 4, CMV disease occurred in 5 of 74 recipients of an HLA-identical family member transplant at a m edian of 137 days post-transplant and was associated with concurrent m oderate to severe GVHD in 4 of the 5. Thus the risk of CMV disease was higher in recipients who were not genotypically identical for HLA wit h their donors and who (in consequence) were given more immune-suppres sion than KLA-identical family member transplant recipients. Additiona lly, CMV disease can occur beyond the period of prophylactic ganciclov ir administration (first 3 months post-transplant) in patients develop ing significant chronic GVHD and prophylaxis should be reintroduced at that time in such patients.