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Blood, 15 January 2001, Vol. 97, No. 2, pp. 388-392
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Cidofovir for cytomegalovirus infection and disease in allogeneic
stem cell transplant recipients
Per Ljungman,
Giorgio
Lambertenghi Deliliers,
Uwe Platzbecker,
Susanne Matthes-Martin,
Andrea Bacigalupo,
Hermann Einsele,
Johanna Ullmann,
Maurizio Musso,
Rudolf Trenschel,
Patricia Ribaud,
Martin Bornhäuser,
Simone Cesaro,
Bruce Crooks,
Adrian Dekker,
Nicole Gratecos,
Thomas Klingebiel,
Elena Tagliaferri,
Andrew J. Ullmann,
Pierre Wacker, and
Catherine Cordonnier for the
Infectious Diseases Working Party of the European Group for
Blood and Marrow Transplantation
From Huddinge University Hospital, Stockholm,
Sweden; St Anna Kinderspital, Vienna, Austria; Hôpital St Louis,
Paris; Hôpital de l'Archet, Nice; and Hôpital Henri
Mondor, Creteil, France; University Hospital, Dresden; University
Hospital Tübingen, Tübingen; Klinikum Grosshadern, Munich;
University Hospital, Essen; and Johannes-Gutenberg-University, Mainz,
Germany; Ospedale Maggiore di Milano, Milan; Ospedale San Martino,
Genoa; University Hospital Palermo, Palermo; and University Hospital,
Padua, Italy; University Hospital, Utrecht, The Netherlands;
Hôpital Cantonal, Geneva, Switzerland; and Newcastle General
Hospital, Newcastle upon Tyne, United Kingdom.
A retrospective study was performed to collect information
regarding efficacy and toxicity of cidofovir (CDV) in
allogeneic stem cell transplant patients. Data were available
on 82 patients. The indications for therapy were cytomegalovirus (CMV)
disease in 20 patients, primary preemptive therapy in 24 patients, and secondary preemptive therapy in 38 patients. Of the patients, 47 had
received previous antiviral therapy with ganciclovir, foscarnet, or
both drugs. The dosage of CDV was 1 to 5 mg/kg per week
followed by maintenance every other week in some patients. The duration of therapy ranged from 1 to 134 days (median, 22 days). All patients received probenecid and prehydration. Ten of 20 (50%) patients who
were treated for CMV disease (9 of 16 with pneumonia) responded to CDV
therapy, as did 25 of 38 (66%) patients who had failed or relapsed
after previous preemptive therapy and 15 of 24 (62%) patients in whom
CDV was used as the primary preemptive therapy. Of the patients, 21 (25.6%) developed renal toxicity that remained after cessation of
therapy in 12 patients. Fifteen patients developed other toxicities
that were potentially due to CDV or the concomitantly given probenecid.
No toxicity was seen in 45 (61.6%) patients. Cidofovir can be
considered as second-line therapy in patients with CMV disease failing
previous antiviral therapy. However, additional studies are
needed before CDV can be recommended for preemptive therapy.
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