Cidofovir for cytomegalovirus infection and disease in allogeneic stem cell transplant recipients

A retrospective study was performed to collect information regarding effica cy and toxicity of cidofovir (CDV) in allogeneic stem cell transplant patie nts. Data were available on 82 patients. The indications for therapy were c ytomegalovirus (CMV) disease in 20 patients, primary preemptive therapy in 24 patients, and secondary preemptive therapy in 38 patients. Of the patien ts, 47 had received previous antiviral therapy with ganciclovir, foscarnet, or both drugs. The dosage of CDV was 1 to 5 mg/kg per week followed by mai ntenance every other week in some patients. The duration of therapy ranged from 1 to 134 days (median, 22 days). Ail patients received probenecid and prehydration. Ten of 20 (50%) patients who were treated for CMV disease (9 of 16 with pneumonia) responded to CDV therapy, as did 25 of 38 (66%) patie nts who had failed or relapsed after previous preemptive therapy and 15 of 24 (62%) patients in whom CDV was used as the primary preemptive therapy. O f the patients, 21 (25.6%) developed renal toxicity that remained after ces sation of therapy in 12 patients. Fifteen patients developed other toxiciti es that were potentially due to CDV or the concomitantly given probenecid. No toxicity was seen in 45 (61.6%) patients. Cidofovir can be considered as second-line therapy in patients with CMV disease failing previous antivira l therapy. However, additional studies are needed before CDV can be recomme nded for preemptive therapy. (C) 2001 by The American Society of Hematology .