Impacto de la carga vírica inicial de citomegalovirus sobre la eficacia del tratamiento anticipado con ganciclovir en receptores de trasplante de progenitores hematopoyéticos

Objective: To study the impact of initial cytomegalovirus (CMV) viral load on virological response to ganciclovir preemptive therapy in allogeneic stem cell transplant (SCT) recipients after 4 weeks of treatment. Methods: Eighty-one consecutive allogeneic SCT recipients were included. Preemptive therapy was initiated when CMV load was positive for 2 consecutive weeks or when a viral load 45000 copies/mL was detected in 1 sample. If viral load was 4400 copies/mL after 2 weeks of treatment, maintenance treatment with ganciclovir was continued for 2 additional weeks. Virological failure was defined as a CMV load 4400 copies/mL after 4 weeks of treatment. Results: Ganciclovir preemptive therapy was initiated in 32 patients (39.5%) who had 39 episodes of CMV replication. Virological failure occurred in 16 patients (50%) after 18 episodes of replication (46%). Clinical failure additionally occurred in 2 episodes (5%). The only risk factor for virological failure was a peak viral load 420 000 copies/mL at the beginning of treatment (OR 5.88; 95% CI: 1.49–25, P ¼ .03). The main risk factor for CMV replication 420 000 copies/mL at the start of treatment was the presence of grade II–IV acute graft-versus-host-disease (OR 16; 95% CI: 8.5–45).