Randomized study of valacyclovir as prophylaxis against cytomegalovirus reactivation in recipients of allogeneic bone marrow transplants

Per Ljungman*, Rafael De la Camara, Noel Milpied, Liisa Volin, Charlotte A. Russell, Adam Crisp, Alison Webster, R. Herrmann, S. Durrant, H. Greinix, A. Ferrant, R. Schots, D. Bron, D. Seleslagh, L. Vindelov, J. Nikoskelainen, E. Gluckman, D. Blaise, J. Cahn, J. ReiffersM. Attal, G. Ehninger, N. Schmitz, H. Link, R. A. Zander, McCann, G. Crotty, R. Or, F. Martelli, S. Tura, P. Di Bartolomeo, F. Mandelli, D. A. Bosi, M. Abecassis, Lacerda, P. Jacobs, M. Sanz, A. Domingo-Albos, C. Rozman, A. Tores-Gomez, F. J. Lopez, G. Öberg, A. Fasth, S. Rödger, P. G. Nilsson, R. E. Clark, H. G. Prentice, R. Powles, S. Proctor, E. J. Kanfer, A. Foot

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

135 Scopus citations

Abstract

Oral valacyclovir for cytomegalovirus (CMV) prophylaxis in bone marrow transplantation (BMT) was investigated in a randomized, double-blind, acyclovircontrolled, multicenter clinical trial in recipients of allogeneic BMT who were CMV seropositive (or donor positive) before transplantation and were aged 13 years or older. Patients were randomized before BMT. All initially received intravenous acyclovir (500 mg/m2) 3 times daily until day 28 after transplantation or after discharge, then oral valacyclovir (2 g) or acyclovir (800 mg) 4 times daily until week 18 after transplantation. Evidence of CMV infection, CMV disease, and death were documented for 22 weeks. Primary end points were time to CMV infection (detection of CMV in blood, bronchoalveolar lavage) or CMV disease and survival. Preemptive CMV therapy was permitted. Seven hundred twenty-seven patients were evaluable for efficacy. After the administration of intravenous acyclovir, valacyclovir was significantly more effective than oral acyclovir in reducing the incidence of CMV infection. CMV infection or disease developed in 102 (28%) valacyclovir patients, compared with 143 (40%) acyclovir patients (HR, 0.59; 95% Cl, 0.46-0.76; P < .0001). Survival did not differ between treatments (76% and 75% in the valacyclovir and acyclovir groups, respectively). The safety of oral valacyclovir was similar to that of high-dose oral acyclovir. Valacyclovir was more effective than acyclovir in preventing CMV reactivation in BMT recipients and showed a similar safety profile. CMV disease incidence was low, and no differences were observed between oral valacyclovir and acyclovir. Survival was similar in each group. Valacyclovir prophylaxis provides a clinically valuable intervention but must be part of an overall strategy for CMV prevention in BMT.

Original languageEnglish (US)
Pages (from-to)3050-3056
Number of pages7
JournalBlood
Volume99
Issue number8
DOIs
StatePublished - Apr 15 2002

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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