1200. Treatment of Cytomegalovirus (CMV) Disease after Transplantation: Does a Shorter Duration of Treatment after Viremia Eradication Lead to a Higher Rate of Relapse?
Session: Poster Abstract Session: Transplant: Epidemiology of Infections in Transplant Patients and Other Patients with Impaired Immunity
Friday, October 9, 2015
Room: Poster Hall
Background: Quantitative CMV nucleic acid testing (QNAT) has been optimized with the use of the World Health Organization calibration standard (WHO-CA). In a comparative study, we observed that patients with CMV infection who were monitored with standardized WHO-CA QNAT had significantly shorter duration of treatment, compared to those monitored by a laboratory developed test (LDT). The shorter duration was attributed to earlier discontinuation of antiviral therapy after achieving an undetectable viral load (11 days [range: 6–17] in the WHO-CA group versus 18 days [13–26] in the LDT group, p=0.002). In the present study, we hypothesize that this shorter abbreviated duration of antiviral treatment, by one full week, is associated with a higher rate of viral relapse.  

Methods: All patients included in the original study were followed clinically for a period of up to 6 months after discontinuation of antiviral treatment. 

Results: The study population consisted of 110 solid organ and allogeneic hematopoietic stem cell transplant recipients with a total of 125 episodes of CMV disease. There was no significant difference in median age, gender, type of transplant and type of CMV disease between the WHO-CA group and the LDT group. At 6 months, CMV relapse was observed in 25% of all patients, including 14/64 (22%) CMV episodes monitored by WHO-CA compared to 17/61 (28%) of CMV episodes monitored by LDT; the difference was not statistically significant (p=0.232). 

Conclusion: Current guidelines recommend that antiviral treatment be continued until two weekly negative CMV QNAT (which is at least 14 days of negative viral load in the blood). This study challenges this approach, since the rate of CMV relapse did not increase significantly despite a duration shorter than the recommended 14 days after viremia eradication; this could therefore translate to improved cost savings and less toxicity. However, the rate of CMV relapse remains notably high, and analysis of factors predisposing to CMV relapse should be performed.  

Maria Dioverti, M.D., Mayo Clinic, Rochester, MN, Brian Lahr, MS, Biomedical Statistics and Informatics, Mayo Clinic, College of Medicine, Rochester, MN and Raymund R. Razonable, MD, FIDSA, Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN


M. Dioverti, None

B. Lahr, None

R. R. Razonable, None

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