Background: High-dose ganciclovir (GCV) is often used for treatment of high viral load CMV, but few data exist on virologic outcomes and risk of neutropenia. Methods: Demographic, clinical, virologic, antiviral data were retrospectively collected on transplant recipients with CMV viral loads >50,000 IU/mL (1/2012-5/2016). Viral loads before 4/2013 were converted to IU/mL with a factor of 0.9. Patients with IV GCV doses that were high relative to renal function were the “high-dose” group. Clearance was defined as 2 consecutive undetectable CMV PCR's at least 1wk apart. Results: 67 patients (15 HCT, 52 SOT) had 69 episodes; 32/69 (46%) had high-dose GCV (29 SOT, 3 HCT). All but 3 had at least a 1-log fall in viral load; most were later switched to standard-dose GCV or valganciclovir (VGCV). In SOT, neutropenia (ANC<1000) occurred in 19/29 (66%) of high-dose and 14/24 (58%) standard-dose (p=0.77). Resistance mutations were found in 14/30(47%) tested: 1 cleared with high-dose GCV(L595S), 1 with high-dose VGCV(A594V), and 1 fell to detectable <137 IU/mL with standard-dose GCV(M460V, A594V). All others with resistance required other antivirals. Conclusions: Nearly half of patients with high CMV PCR's received high-dose GCV, and 3/14 with GCV resistance responded. Neutropenia was common with both dosing strategies. Further study is needed to determine which patients benefit from high-dose GCV.

CITATION INFORMATION: Alfares M, Avery R, Turki N, Alfares K, Mehta S, Boger R, Valsamakis A. Utility of “High-Dose” Ganciclovir in High Viral Load CMV Infection in Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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