PREVENTION OF CMV DISEASE IN ALLOGENEIC BMT RECIPIENTS BY CYTOMEGALOVIRUS ANTIGENEMIA-GUIDED PREEMPTIVE GANCICLOVIR THERAPY

Purpose: Cytomegalovirus (CMV) infection can cause severe disease and mortality in recipients of allogeneic bone marrow transplants (alloBMT ) when either the donor or recipient is CMV seropositive (high-risk al loBMT). We investigated the efficacy of preemptive therapy guided by d etection of CMV antigenemia Methods: In 11 high-risk alloBMT recipient s, high-dose ganciclovir (GCV) treatment was initiated at first positi ve antigenemia and was continued until antigenemia became negative. Re sults: The treatment strategy prevented CMV disease during the follow- up period of the study in 7 alloBMT recipients with positive CMV antig enemia. Three other patients who were shown to be CMV antigenemia nega tive but positive for CMV DNA in blood by the polymerase chain reactio n (PCR) were not treated and did not develop CMV disease. The eleventh patient was negative for CMV by all tests for the duration of the stu dy and did not develop CMV disease. Conclusions: We have found antigen emia-guided preemptive GCV therapy to be an effective strategy for the prevention of CMV disease in high-risk alloBMT recipients.