Risk-adapted pre-emptive therapy for cytomegalovirus disease in patients undergoing allogeneic bone marrow transplantation

We prospectively evaluated a risk-adapted pre-emptive treatment with gancic lovir for CMV diseases in patients undergoing allogeneic bone marrow transp lantation (BMT), High-level CMV antigenemia (10 or more positive cells on t wo slides) or CMV antigenemia at any level in patients with grade II-IV acu te graft-versus-host disease (aGVHD) were chosen as risk factors, We also r etrospectively evaluated virus reactivation in plasma using quantitative re al-time polymerase chain reaction (PCR). Fifty patients were evaluable, Non e of the 27 patients with or without grade I aGVHD developed high-level CMV antigenemia or CMV disease, Among the 23 patients with grade II-IV aGVHD, 12 patients (52%) developed CMV antigenemia and were treated pre-emptively, of whom two developed CMV gastroenteritis or retinitis in spite of therapy . Six of the remaining 11 patients developed CMV gastroenteritis before CMV antigenemia was detectable, All of the eight patients with CMV diseases we re successfully treated with ganciclovir and no deaths directly related to CMV disease occurred. In four of the seven evaluable patients with CMV gast roenteritis, real-time PCR was able to detect virus reactivation earlier th an CMV antigenemia. Although our risk-adapted pre-emptive therapy effective ly reduced CMV-related mortality, further refinements of this approach, par ticularly in the prevention of CMV gastroenteritis, may be achieved by inco rporating real-time PCR.