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

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

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