Valgancyclovir Significantly Reduced Reactivation of CMV Following Mini-Transplantation with MAP (Mitoxantrone, Ara-C, and Pentostatin) Regimen.

CMV reactivation remains a significant morbidity following allogeneic transplantation. IV gancyclovir may cause myelosuppresion and renal toxicity. It is reserved for the therapy of CMV reactivation. We initiated prophylaxis with Valgancyclovir (Valcyte, manufactured by Hoffman-LaRoche), an oral pro-drug of gancyclovir, against CMV reactivation in patients with CMV exposure history. The Valgancyclovir was given as 450 mg po BID three times a week when post-transplant WBC exceed 1500. In this study, 50 patients who received mini-allogeneic hematopoietic stem cell transplantation following MAP regimen (mitoxantrone, AraC, pentostatin) were included for analysis. 30 patients had prior exposure to CMV (pre-transplant CMV IgG + for patient and /or donor), 20 patients had no evidence of prior exposure. Among the 30 patients who had exposure, 10 patients had antigenemia. Among the 20 patients who did not have exposure history, 2 had CMV antigenemia. Among the 30 patients who had exposure, 19 received Valgancyclovir prophylaxis, 10 received acyclovir, and 1 received gancyclovir. 2 of 19 patients (10%) among the valgancyclovir group had CMV antigenemia, whereas 8 of 11 (72%) who did not receive valgancyclovir prophylaxis had CMV antigenemia (table 1). We conclude that valgancyclovir prophylaxis significantly reduced CMV reactivation (p=0.0009) in patients who had history of CMV exposure and received mini-transplantation after MAP conditioning regimen.

CMV reactivation post-minitransplantation with MAP regimen