Valganciclovir Preferred to Prevent Cytomegalovirus After Allogeneic Hematopoietic Cell Transplantation

Patients undergoing allogeneic hematopoietic cell transplantation (HCT) are susceptible to developing cytomegalovirus after the procedure, and current antiviral preemptive therapy (PET) is often stunted by toxicity concerns.

A new real-world study at Memorial Sloan Kettering Cancer Center sought to analyze PET and associated toxicities in 232 HCT recipients, some considered high risk (HR) and some low risk (LR) for CMV, through day 100 post-HCT.

In a poster presented at the 2019 Transplantation & Cellular Therapy Meetings of ASBMT and CIBMTR, investigators detailed the study pool of CMV-seropositive adults who received bone-marrow or peripheral blood HCT between January 1, 2015, and December 31, 2017. The participants were subjected to routine monitoring by quantitative CMV polymerase chain reaction, and investigators analyzed the rate, type, and sequence of any administered PET.

A total of 121 (52%; 40 low risk and 81 high risk) patients received PET, which was started at a median 35-day post-HCT [HR vs. LR: 32 vs. 39, P<0.0001].

“CMV viral load (VL) at PET initiation was <137 IU/mL in 23 patients; and median of 475 IU/ml in 98 patients. Valganciclovir was the most common 1^st PET (55%), followed by foscarnet (26%) and ganciclovir (19%),” investigators wrote in the abstract. “Sixty-five patients completed planned 1^st PET regimen; 33.1% discontinued 1^st PET due to either clinical toxicity (20.7%) or lack of virologic response (12.4%). Subsequently, 2^nd and 3^rd PET agents were administered to 46.1% and 20.7% of patients respectively. Median duration of PET was 37 days [HR vs. LR: 41 vs. 30.5, P = 0.011].”

The team concluded that valganciclovir was the preferred first-line PET agent, with the first PET discontinuation or change made due to clinical or laboratory-defined toxicity occurring with similar frequency between HR and LR patients.

The poster, “Toxicities of CMV Preemptive Therapy in the First 100 Days after Allogeneic Hematopoietic Cell Transplantation (HCT): A Real-World Study at Memorial Sloan Kettering Cancer Center,” was presented Saturday, February 23, 2019, at the Transplantation & Cellular Therapy Meetings of ASBMT and CIBMTR in Houston, Texas.