valganciclovir and Multiple-Myeloma

Topics: ADP-ribosyl Cyclase 1; Aged; Antibodies, Monoclonal; Antineoplastic Agents, Immunological; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Dexamethasone; Drug Evaluation; Female; Ganciclovir; Humans; Immunocompromised Host; Lenalidomide; Lymphocytes; Male; Membrane Glycoproteins; Middle Aged; Multiple Myeloma; Recurrence; Retrospective Studies; Valganciclovir; Virus Activation

Multiple myeloma is rare B cell malignancy that affects elderly. Therapeutic regimens consist of high dose chemotherapy followed by haematopoietic stem cell transplantation (HSCT). Both humoral and cell mediated immunities are compromised in these patients, leading to increased susceptibility to infections. Here, we report a case of 62-year male with multiple myeloma who developed infection with three viruses from herpes family during the first cycle of chemotherapy.

Topics: Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Cytomegalovirus; Fatal Outcome; Herpesvirus 1, Human; Herpesvirus 4, Human; Humans; Immunocompromised Host; Male; Middle Aged; Multiple Myeloma; Stem Cell Transplantation; Transplantation, Autologous; Valganciclovir

Topics: Adult; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Ganciclovir; Humans; Male; Middle Aged; Multiple Myeloma; Stem Cell Transplantation; Valganciclovir; Viremia

It is uncertain whether monitoring plasma ganciclovir (GCV) levels is useful in predicting cytomegalovirus (CMV) DNAemia clearance in preemptively treated allogeneic stem cell transplant recipients. In this observational study, including 13 episodes of CMV DNAemia treated with intravenous (i.v.) GCV or oral valganciclovir, we showed that monitoring trough plasma GCV levels does not reliably predict response to therapy. Rather, immunological monitoring (pp65 and immediate-early [IE]-1-specific gamma interferon [IFN-γ]-producing CD8+ T cells) appeared to perform better for this purpose.

Topics: Adult; Anemia, Aplastic; CD8-Positive T-Lymphocytes; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Female; Ganciclovir; Humans; Interferon-gamma; Leukemia, Myeloid, Acute; Lymphoma, Non-Hodgkin; Male; Middle Aged; Multiple Myeloma; Phosphoproteins; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Stem Cell Transplantation; Transplant Recipients; Valganciclovir; Viral Matrix Proteins

Cytomegalovirus (CMV) retinitis is an uncommon manifestation of CMV disease and is a marker of severe and profound immunosuppression in human immunodeficiency virus-positive patients. Here, we describe 2 cases of CMV retinitis in myeloma patients with progressive disease, following autologous stem cell transplantation and immunomodulatory therapy for myeloma. To our knowledge, this is the first report of CMV retinitis in this patient population. This report illustrates the need for close monitoring of relapsed and refractory myeloma patients for new presentations of opportunistic infections secondary to severe immunosuppression.

Topics: Aged; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Retinitis; Dexamethasone; Fatal Outcome; Female; Ganciclovir; Humans; Immunosuppression Therapy; Male; Multiple Myeloma; Stem Cell Transplantation; Valganciclovir

Topics: ABO Blood-Group System; Antiviral Agents; Blood Group Incompatibility; Boronic Acids; Bortezomib; Cytomegalovirus Infections; Doxorubicin; Ganciclovir; Hemagglutinins; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Multiple Myeloma; Protease Inhibitors; Pyrazines; Valganciclovir

Despite significant advances in prevention and therapy, cytomegalovirus (CMV) infection continues to be an important cause of morbidity and mortality in the hematopoietic stem cell transplant (HSCT) recipient. The standard drug for pre-emptive therapy is intravenous ganciclovir (GCV). Valganciclovir (VGC), the oral pro-drug of GCV, has excellent bioavailability and is ideal for oral therapy. Since March 2002, VGC was adopted in our center for outpatient pre-emptive therapy in all patients undergoing allogeneic HSCT. Fifty-two allogeneic HSCT recipients were followed weekly via Digene hybrid capture assay. Patients with a positive assay were treated with VGC 900 mg p.o. b.i.d. x 14 days followed by 900 mg p.o. QD until at least 7 days after a negative test. Eighteen patients (14 sib, four MUD) had 30 episodes of CMV DNA detection treated with oral VGC. Median duration of therapy was 21 days (range 10-21 days). The rate of response was 93% (28/30) as confirmed by a negative assay within 14 days. No significant toxicity was encountered. Two patients failed oral VGC. One case of CMV enteritis was diagnosed in a patient with acute GVHD. Pre-emptive therapy of CMV infection with oral VGC is safe and effective in allogeneic HSCT recipients.

Topics: Administration, Oral; Adult; Antiviral Agents; Biological Availability; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Immunosuppressive Agents; Leukemia; Male; Middle Aged; Multiple Myeloma; Myelodysplastic Syndromes; Retrospective Studies; Stem Cell Transplantation; Transplantation, Homologous; Treatment Failure; Treatment Outcome; Valganciclovir; Whole-Body Irradiation