PRE-TRANSPLANT GANCICLOVIR PROPHYLAXIS TO PREVENT CMV INFECTIONS IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS

Abstract

Background: The spectrum of human illness caused by cytomegalovirus (CMV) is diverse and mostly depended on the host. CMV infections in immunocompromised patients cause substantial morbidity and mortality, especially among transplant recipients. Most centers favor a pre-emptive approach for CMV in haematopoietic stem cell transplantation rather than a prophylactic approach to minimize toxicity from anti-viral agents. This study was done to determine the frequency of Cytomegalovirus reactivation and symptomatic infections with pre-transplant prophylactic ganciclovir versus no prophylaxis in patients undergoing allogenic haematopoietic stem cell transplantation. This study assessed the incidence of non-relapse mortality and overall survival for the first 100 days post-transplant in patients undergoing allogenic haematopoietic stem cell transplantation and receiving pre-transplant prophylactic ganciclovir versus those who received no prophylaxis.

Material and Methods: This Retrospective comparative observational study was conducted at the Department of Clinical Hematology and Bone Marrow Transplant, Shifa International Hospital, Islamabad, 01 Jan 2017 to 31 Jul 2021.A total of 106 patients, who underwent allogenic haematopoietic stem cell transplant, were included in this study for retrospective analysis between 2017 and 2021. Patients who received ganciclovir prophylaxis were placed in Group A while those that didn’t were placed in Group B. Ganciclovir was administered at a dose of 5 mg/kg twice daily seven days prior to transplant and ceased on the day of transplant. All patients were placed on acyclovir 400 mg twice daily from day 0 to day 100 of transplant. Patients received a weekly or bi-weekly test for quantitative serum CMV PCR till day 100 post-transplant. CMV reactivation was defined as a viremia of greater than 150 IU/ml. Data was analyzed using SPSS 26.0.

Results: Ganciclovir prophylaxis was associated with a lower degree of CMV reactivation: 38 (61.3%) with prophylaxis versus 44 (89.8%) without prophylaxis, but with a higher rate of transplant related mortality, 14 (22.5%) with prophylaxis, vs. 4 (8.1%) without prophylaxis The increased transplant related mortality was likely due to primary engraftment failure in 7 (11.2%) with prophylaxis, while no cases of engraftment failure were seen without prophylaxis.

Conclusion: CMV prophylaxis with ganciclovir is effective in preventing CMV reactivation at the cost of increased transplant related mortality in the form of primary engraftment failure.

Keywords: Allogenic haematopoietic Stem cell transplantation, Cytomegalovirus, Ganciclovir prophylaxis