HUMAN CYTOMEGALOVIRUS (HCMV) INFECTION IN PEDIATRIC-PATIENTS GIVEN ALLOGENEIC BONE-MARROW TRANSPLANTATION - ROLE OF EARLY ANTIVIRAL TREATMENT FOR HCMV ANTIGENEMIA ON PATIENTS OUTCOME

In a prospective study, we evaluated the role of early treatment with ganciclovir of human cytomegalovirus (HCMV) pp65-antigenaemia, as well as the risk factors related to the infection in 48 paediatric patient s given an allogeneic bone marrow transplantation (BMT). HCMV infectio n occurred in 24 children, the overall actuarial risk of infection at 120 d being 51%. Development of acute graft-versus-host disease (GVHD) , steroid therapy and serological status of both recipient and donor w ere the most powerful predictors of HCMV infection, none of the six se ronegative patient/donor pairs developing HCMV infection. Considering only the seropositive recipients and patients given a seropositive mar row (42 cases), the actuarial risk of developing HCMV antigenaemia in patients with acute GVHD was 76% v 27% in those with or without GVHD ( P < 0.005) and 79% v 15% respectively in patients who did or did not r eceive steroid therapy (P < 0.001). HCMV disease developed in 5/24 chi ldren with pp65-antigenaemia, which was detected before diagnosis in a ll cases but one. All patients with pp65-positive cells were treated w ith ganciclovir at a dose of 5 mg/kg twice daily for 14 d. In patients without acute GVHD no maintenance therapy was administered, whereas c hildren with active acute GVHD were given additional therapy with ganc iclovir at a dose of 5 mg/kg/d for 14 d. Ganciclovir produced complete clearing of viraemia and antigenaemia, with some patients presenting recurrences of antigenaemia, which were treated according to the above -mentioned schedule. Likewise, HCMV disease completely resolved after treatment with ganciclovir and no patients died from HCMV-related inte rstitial pneumonia. Our results suggest that an early short-term thera py with ganciclovir after demonstration of antigenaemia can be effecti ve in reducing or abolishing HCMV-related mortality. This approach eli minates the use of ganciclovir in patients not presenting HCMV reactiv ation and therefore not benefiting from therapy. The administration of ganciclovir limited to the period needed to obtain antigenaemia clear ance could also have the advantage of reducing myelotoxicity.