POLYMERASE CHAIN-REACTION MONITORING REDUCES THE INCIDENCE OF CYTOMEGALOVIRUS DISEASE AND THE DURATION AND SIDE-EFFECTS OF ANTIVIRAL THERAPY AFTER BONE-MARROW TRANSPLANTATION

Culture-based preemptive therapy with ganciclovir was shown to reduce the incidence of cytomegalovirus (CMV) disease after bone marrow trans plantation (BMT). Culture techniques did not detect CMV in 12% to 13% of patients before the onset of CMV disease. In a prospective study, 7 1 patients either received preemptive therapy based on polymerase chai n reaction (PCR) technique (37 patients) or on culture assays (34 pati ents). In both groups, therapy was continued until clinical signs disa ppeared and PCR negativity was documented. Twenty-two patients in the PCR group and 15 patients in the culture group received antiviral ther apy. PCR allowed detection of the virus (median day, +32 v day +49; P = .006) and introduction of antiviral therapy (median day, +44 v day 54; P = .02) earlier than did culture assays. The incidences of CMV di sease (2 of 37 v 8 of 34 in PCR group v culture group, respectively; P = .02) and CMV-associated mortality (0 of 37 v 5 of 34 in PCR group v culture group, respectively; P = .02) were decreased, and the duratio n of ganciclovir therapy (P < .001) was shorter in the PCR-monitored g roup. Incidence and median duration of severe neutropenia (less than 5 00/mu L) were lower in the PCR group (two v eight episodes, P = .02; m edian duration, 1.5 v 5 days, P = .04), as was the incidence of nonvir al infections during/after antiviral therapy (2 of 37 v 9 of 34; P = . 012). Thus, preemptive therapy based on more sensitive detection metho ds such as the PCR assay reduces the incidence of CMV disease and CMV- related mortality. Additionally, stopping and withholding antiviral th erapy in a PCR-negative patient is safe and allows reduction of the du ration and side effects of antiviral therapy. (C) 1995 by The American Society of Hematology.