EFFECT OF HIGH-DOSE ACYCLOVIR ON SURVIVAL IN ALLOGENEIC MARROW TRANSPLANT RECIPIENTS WHO RECEIVED GANCICLOVIR AT ENGRAFTMENT OR FOR CYTOMEGALOVIRUS PP65 ANTIGENEMIA

This study sought to determine whether high-dose acyclovir improves po sttransplant survival in cytomegalovirus (CMV)-seropositive patients w hen ganciclovir is given for prophylaxis or as early therapy. Three gr oups were studied: Group 1 (n = 112) received ganciclovir from engraft ment without prior acyclovir treatment, group 2 (n = 114) was given ga nciclovir for CMV pp65 antigenemia without prior acyclovir, and group 3 (n = 133) received ganciclovir at engraftment with prior intravenous acyclovir (500 mg/m(2) every 8 h) from day 5 before transplant until engraftment, In a multivariable Cox model, there was no significant di fference in the adjusted risk of transplant survival between the group s during the first 2 years after transplant (relative risk for mortali ty: group 1, 1.0; group 2, 0.75 (95% confidence interval [CI], 0.52-1. 1); group 3, 1.04 (95% CI, 0.74-1.47). The incidence of CMV disease an d CMV-related mortality was not significantly different between the gr oups. Thus, high-dose acyclovir does not appear to improve survival wh en ganciclovir is given either at engraftment or for CMV pp65 antigene mia.