Risk factors for treatment failures in patients receiving PCR-based preemptive therapy for CMV infection

PCR-based preemptive therapy with ganciclovir has been shown to reduce the incidence of CMV disease after BMT, Failures of this treatment strategy are CMV disease and secondary non-viral infections. Eighty-six consecutive pat ients at high risk for CMV disease who received PCR-based preemptive therap y with ganciclovir were assessed for treatment failures and possible risk f actors. Ganciclovir was initiated in 57 of 86 patients (66%), Only 28 of 86 (32%) patients received 4 or more weeks of ganciclovir, Recurrence of CMV infection after successful treatment was more frequent among recipients of a BMT from an unrelated compared to a sibling donor (P = 0.004). Three (3.5 %) patients developed non-fatal early onset CMV disease and seven of 68 (10 .3%) late onset CMV disease (>100 days post transplant). Risk factors for l ate onset CMV disease were cGVHD (P = 0.0017) and duration of prior antivir al therapy >4 weeks (P = 0.0073). The incidence of secondary non-viral infe ctions was 28% with the duration of antiviral treatment being a significant risk factor for secondary bacterial (P = 0.0045) and invasive fungal infec tions (P = 0.006). Thus, PCR-based preemptive treatment with ganciclovir re duces early onset CMV disease, but the duration of antiviral therapy prior to day +100 is a significant risk factor for late onset CMV disease as well as secondary non-viral infections.