Evaluation of cytomegalovirus reactivation and tolerability in seropositive umbilical cord transplant patients after implementation of an intensive prevention strategy

Objective/Background Cytomegalovirus (CMV) causes significant morbidity and mortality in CMV seropositive patients undergoing umbilical cord blood transplants (UCBT). Our study aimed to describe the incidence of CMV reactivation and burden of disease, as well as the tolerability of an intensive prevention strategy as compared to historical prevention. Methods This was a retrospective chart review of 33 CMV seropositive patients that underwent UCBT. The intensive prevention strategy in UCBT consisted of ganciclovir 5 mg/kg/d intravenously or valganciclovir 900 mg by mouth daily initiated at the beginning of the conditioning regimen until Day −2. Then from Day −1 to Day +100, patients received valacyclovir 2 g by mouth three times daily, and from Day +101 to Day +365, acyclovir 800 mg by mouth twice daily. Historical standard prevention was acyclovir 800 mg by mouth twice daily initiated at the beginning of the conditioning regimen until Day +365. Results Thirty-three patients were included from 2008 to 2014. There were no differences in the adverse effects experienced between the two regimens (p = .4). CMV reactivation occurred significantly later with intensive prevention (p = .003). The median CMV viral titer at reactivation was lower in the intensive versus the historic prevention (1,800 copies/mL and 2,700 copies/mL, respectively), but was not significantly different. CMV disease occurred significantly less often in the intensive group (p = .039). Conclusion The results from this study indicate that the intensive prevention strategy was well tolerated, significantly delayed CMV reactivation, and patients had less CMV disease.