Hammerstrom AE, et al. - In this retrospective analysis, haploidentical hematopoietic cell transplantation (HCT) recipients were analyzed to assess whether a more intensified antiviral strategy would reduce the incidence of cytomegalovirus (CMV) reactivation compared with a traditional antiviral prophylaxis regimen. Findings suggested the utility of an intensified approach to prevention of CMV reactivation in lowering the incidence of CMV reactivation and reducing CMV disease without increased toxicity. As the most benefit was identified in the intensified group, there appeared a necessity for further studies to assess which antiviral intervention would be the most beneficial in lowering the rates of CMV viremia and disease.

Methods

• In accordance to practice changes over time in antiviral prophylaxis at their institution, researchers divided the patients into the following three groups: hybrid (n=15), traditional (n=26), and intermediate-dose (n=45).
• Valganciclovir was administered to the hybrid group from admission to day -2 followed by standard dose valacyclovir.
• Standard dose valacyclovir was administered to the traditional group, starting on day -1.
• The intermediate-dose group was administered ganciclovir from admission through day -2, followed by intermediate dose valacyclovir.
• For further analysis, the hybrid and intermediate-dose groups were combined into an intensified group.

Results

• For patients receiving the traditional strategy, findings revealed higher cumulative incidence (CI) of CMV reactivation within 100 days post-HCT compared with the hybrid and intermediate-dose strategy groups (81% vs. 53% vs. 71%, respectively; p = 0.08) and this was significantly higher when the traditional group was compared against the intensified group (81% vs. 67%, respectively; p=0.032).
• In addition, shorter median time to CMV reactivation was evident in the traditional group versus the intensified group (31 days vs. 41 days, respectively).
• Furthermore, by day 100, the CI of CMV disease was markedly worse for patients receiving the traditional prophylaxis strategy among the three groups (8% traditional vs. 0% hybrid vs. 0% intermediate-dose; p = 0.032).
• There appeared no differences regarding renal toxicity between the traditional and intensified group.