Vol.63 No.6 November 2015
Safety and efficacy of foscarnet for preemptive therapy against cytomegalovirus reactivation following unrelated bone marrow transplantation
1)Department of Pharmacy, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
2)Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital
3)Clinical Research Center, Nagasaki University Hospital
Abstract
Foscarnet (FCN) is one of the most important agents used for the treatment of cytomegalovirus (CMV) infections after stem cell transplantation. Ganciclovir, which is the drug of first choice for the treatment of CMV infection following blood-forming stem cell transfusion (following transplantation), also causes serious bone marrow suppression as a side effect. In such cases, FCN must be administered; however, there are few reports on the treatment outcomes in Japan in terms of CMV antigenemia/infections following transplantation, with scarcely any reports at all on the outcomes following bone marrow transplantation between unrelated people. Accordingly, the safety and efficacy of FCN were evaluated in people diagnosed as having CMV antigenemia and administered FCN following bone marrow transplantation between unrelated people at the National Cancer Center Hospital between June 2004 and November 2011. There were a total of 59 subjects, and all could be included in the safety evaluation. Renal dysfunction was observed in 11 cases (Grade 1/2/3 in 3/7/1 cases). Among these, the drug was discontinued or the dose was adjusted in 4 cases. In regard to electrolyte imbalance, hypocalcemia was observed in 27 cases, hypokalemia in 17 cases, and hypomagnesemia in 17 cases; however, discontinuation or dose reduction of FCN was not necessitated in any of the subjects. In the following cases, the severity of bone marrow suppression aggravated to Grade 4 following the start of treatment: 2 cases of leucopenia, 5 cases of decreased platelet count, 2 cases of decreased hemoglobin level in the blood, and 4 cases of a decreased neutrophil count.
Efficacy evaluation was possible in 53 of the 59 cases. The C7-HRP decreased in 39 cases and was no longer detected in 34 cases; it stable in 9 cases, while it increased in 5 cases. Moreover, the rate of decrease of the CMV pp65 antigen titer and the rate of negative conversion were the same as those reported from overseas. These results suggest that FCN may be safely and effectively used in Japan as a remedy for CMV antigenemia following bone marrow transplantation between unrelated people.
Key word
cytomegalovirus, foscarnet, CMV antigenemia, unrelated bone marrow transplantation
Received
April 16, 2015
Accepted
August 25, 2015
Jpn. J. Chemother. 63 (6): 568-575, 2015
