ISSN 1866-8836
Клеточная терапия и трансплантация

Influence of non-CMV specific intravenous immunoglobulin on intravenous ganciclovir effectiveness in patients after allogeneic stem cell transplantation with CMV-disease

Mikhail Y. Drokov, Dmitry S. Tikhomirov, Larisa A. Kuzmina, Tatyana A. Tupoleva, Natalia N. Popova, Vera A. Vasilyeva, Ekaterina D. Mikhaltsova, Olga M. Koroleva, Darya S. Dubnyak, Anna A. Sidorova, Ekaterina V. Usikova, Zoya V. Konova, Anna A. Dmitrova, Tatyana V. Gaponova, Elena N. Parovichnikova, Valery G. Savchenko
National Research Center for Hematology, Moscow, Russian Federation

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Cellular Therapy and Transplantation (CTT)
Volume 7, Number 3
Contents 

Summary

Introduction

Cytomegalovirus (CMV) reactivation is one of the main problems in allogenic hematopoietic stem cell transplantation (allo-HSCT). Use of non-CMV specific intravenous immunoglobulin (IVIG) is still controversial and mostly determined by protocols in every transplant center. Standard of care for CMV-disease is still ganciclovir at 10 mg/kg b.i.d. Here we report data about influence of non-CMV specific IVIG during ganciclovir treatment in allo-HSCT CMV+ patients.

Patients and methods

Thirty two patients with hematological malignancies transplanted in NRCH were included in this study. Detailed patients characteristics are listed in Table 1. All patients were CMV-positive by PCR (Amplisens EBV/CMV/ HHV6-screen-FL”, InterLabService, Russia) and required to start therapy with ganciclovir 10 mg/kg. Patients in IVIG group also received non-CMV specific IVIG during ganciclovir treatment with a median total dose 20 g (7.5-90 g.). Kaplan-Meier estimator was used to determine probability of achievement of CMV-negativity from the time of ganciclovir was started to CMV-negativity (by PCR) or last contact. The log rank test was used to compare differences between the two groups. Fisher’s exact test was used for 2x2 tables. P-value less than 0.05 was considered statistically significant

Results

Impact of IVIG in allo-HSCT patients on probability of achievement of CMV-negativity (by PCR) are shown in the Figure 1. As we can see there is no significant differences on the achievement of CMV-negativity (by PCR) in patients with/without IVIG during ganciclovir therapy.

Conclusion

The use of non-CMV specific immunoglobulins after allo-HSCT is still controversial. According to our data there is no difference between IVIG/no-IVIG groups during ganciclovir treatment. For our opinion use of IVIG, for CMV-disease treatment has not been yet proved. Anyway a large randomized trial is required to determine indications for therapy with IVIG in CMV disease after allo-HSCT.

Disclosures

No relevant conflicts reported.

Keywords

CMV, intravenous immunoglobulin, ganciclovir, allo-HSCT, PCR.

Table 1. Patients characteristics

14_Table 1. Patients characteristics.png
14_Table 1. Patients characteristics_2.png

14_Figure 1. Time to CMV-negativity achievement depending on the therapy mode.png

Figure 1. Time to CMV-negativity achievement depending on the therapy mode


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