Background Ganciclovir (Cymevene) has traditionally been the drug of choice for the treatment of cytomegalovirus infections; it should be administered intravenously because it has low bioavailability. The development of the highly bioavailable prodrug, valganciclovir (Valcyte) has provided an oral option for cytomegalovirus infections.
Purpose The authors evaluated valganciclovir as an alternative in sequential therapy in haematology patients treated with ganciclovir (off-label use).
Materials and methods This was a retrospective observational study lasting 2 years (July 2009–July 2011). The authors included all hospitalised haematology patients who had been treated with ganciclovir. Data were collected: age, sex, haematology disease, ganciclovir (dosage and duration), previous treatment, switch to valganciclovir and date of discharge.
Results The authors included 23 episodes of treatment with ganciclovir involving 21 patients, 9 women and 12 men with median age of 52 years. The most common haematology disease was non-Hodgkin's lymphoma (9 patients) followed by acute myeloid leukaemia (5 patients). 21 episodes of treatment began with ganciclovir 5 mg/kg every 12 h, an induction regimen, then 7 were changed to ganciclovir 5 mg/kg every 24 h, a maintenance regimen. At discharge, 8 patients continued with ganciclovir, 6 (75%) switched to valganciclovir, 5 patients at 900 mg/12 h and 1 patient at 900 mg/24 h. 1 patient was switched to valganciclovir 900 mg/24 h during hospitalisation, treatment continued at discharge. The ganciclovir was discontinued in 12 patients and they were switched to foscarnet (Foscavir) because ganciclovir was associated with leucopenia.
Conclusions Valganciclovir can be the oral alternative to ganciclovir in treatment of cytomegalovirus infections in haematology patients; it does not require hospitalisation for administration. The main limitation on the use of ganciclovir was leucopenia. The use of alternatives such as foscarnet was required in the treatment of cytomegalovirus infections.
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