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Antiviral prophylaxis for cytomegalovirus infection in allogeneic hematopoietic cell transplantation
- Source :
- Blood Advances. 2:2159-2175
- Publication Year :
- 2018
- Publisher :
- American Society of Hematology, 2018.
-
Abstract
- Patients treated with allogeneic hematopoietic cell transplantation (HCT) are at risk of cytomegalovirus (CMV) reactivation and disease, which results in increased morbidity and mortality. Although universal antiviral prophylaxis against CMV improves outcomes in solid organ transplant recipients, data have been conflicting regarding such prophylaxis in patients undergoing allogeneic HCT. We conducted a systematic review of randomized trials of prophylactic antivirals against CMV after allogeneic HCT to summarize the evolution of the field over the last 35 years and evaluate the prophylactic potential of antiviral agents against CMV after allogeneic HCT. Electronic databases were queried from database inception through 31 December 2017. For included studies, incidence of CMV infection and all-cause mortality were collected as primary outcomes; CMV disease incidence, use of preemptive therapy, and drug toxicities were collected as secondary outcomes. Nineteen clinical trials conducted between 1981 and 2017 involving a total of 4173 patients were included for review. Prophylactic strategies included use of acyclovir, valacyclovir, ganciclovir, maribavir, brincidofovir, and letermovir compared with placebo or a comparator antiviral. Fourteen trials that compared antiviral prophylaxis with placebo demonstrated overall effectiveness in reducing incidence of CMV infection (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.42-0.58), CMV disease (OR, 0.56; 95% CI, 0.40-0.80), and use of preemptive therapy (OR, 0.51; 95% CI, 0.42-0.62; 6 trials); however, none demonstrated reduction in all-cause mortality (OR, 0.96; 95% CI, 0.78-1.18) except the phase 3 trial of letermovir (week-24 OR, 0.59; 95% CI, 0.38-0.98). Additional research is warranted to determine patient groups most likely to benefit from antiviral prophylaxis and its optimal deployment after allogeneic HCT.
- Subjects :
- 0301 basic medicine
Ganciclovir
medicine.medical_specialty
medicine.medical_treatment
030106 microbiology
Cytomegalovirus
Brincidofovir
Review Article
Hematopoietic stem cell transplantation
Antiviral Agents
law.invention
03 medical and health sciences
Letermovir
Randomized controlled trial
law
Internal medicine
medicine
Humans
business.industry
Hematopoietic Stem Cell Transplantation
Maribavir
Hematology
Allografts
Transplantation
Clinical trial
Cytomegalovirus Infections
business
medicine.drug
Subjects
Details
- ISSN :
- 24739537 and 24739529
- Volume :
- 2
- Database :
- OpenAIRE
- Journal :
- Blood Advances
- Accession number :
- edsair.doi.dedup.....8fd38ffd1432afe29606aed05dbd8653