DGI-065 Study Using Foscarnet in Haematological Patients
Background Cytomegalovirus (CMV) commonly affects bone marrow transplant patients causing significant morbidity and mortality. Foscarnet is a broad-spectrum antiviral agent, active against CMV, but is not the treatment of choice.
Purpose To find out why it was prescribed, to cheque the treatment efficacy and its adverse effects.
Materials and Methods Retrospective study (2011). Data were obtained from patient clinical records and the pharmacy database. We produced a database with information on demographics, underlying disease, indication, treatment duration, dosage, adverse effects and treatment results based on PCR viral load negativization. We also examined whether there had been prior treatment with ganciclovir and the reason for the change, or the reason for not starting treatment with ganciclovir.
Results 12 patients (8 male) in the haematology department were treated with foscarnet. Median age was 31. Underlying diseases: aplastic anaemia (3), lymphocytic leukaemia (4), myeloblastic leukaemia (1), Hodgkin’s lymphoma (1), Burkitt’s lymphoma (1), T-cell lymphoma (1), myelodysplastic syndrome (1). In 10 cases a bone marrow transplant had been performed. The indication was to treat cytomegalovirus infection except one case in which it was used for suspected infection by herpes virus 6. In 6 patients ganciclovir was not used first (pancytopenia and problems with engraftment). The other 6 patients had been given ganciclovir and switched due to development of resistance (4) and haematological toxicity (2).Treatment started at low doses and increased as tolerated up to 90 mg/kg.
Efficacy: The average length of treatment was 11.4 days. The treatment was effective in 11 patients (91.6%).
Safety: four patients had no toxicity. We found ulcers on the glans (2), impaired renal function (3) (1 of them requiring dialysis and 1 suspension of treatment), hypomagnesemia which responded to magnesium supplements (2) and 3 gastric discomfort.
Foscarnet is an effective alternative in the treatment of CMV infection if there is intolerance or lack of response to ganciclovir.
Worsening renal function is the most important adverse effect.
No conflict of interest.