Background: Valacyclovir has been used for prophylaxis against cytomegalovirus (CMV) infection after\nhematopoietic stem cell transplantation (HSCT). We investigated the efficacy and safety of high-dose Valacyclovir as\npre-emptive therapy in patients with CMV antigenemia after HSCT.\nMethods: In a retrospective single center study of 61 patients, we compared the rates of viral clearance, recurrent\nantigenemia and adverse events in patients with pp65 CMV antigenemia who received high dose Valacyclovir\n(n = 15), Valganciclovir (n = 16), and Foscarnet (n = 30).\nResults: Overall, 60/61 (98 %) of cases achieved CMV antigenemia clearance by day 28, and no patient developed\nCMV disease. After adjusting for age, sex, diagnosis, CMV serological status, donor type, CMV antigen level,\ngraft-versus-host disease (GVHD) therapy, and conditioning regimen, there were no significant differences in the\nrates of viral clearance at day 14 in patients who received Valganciclovir (0.18, 95 % confidence interval (CI) 0.01 to\n2.15, p = 0.17) and Foscarnet (OR 0.22, 95 % CI 0.03 to 2.40, p = 0.22), compared with Valacyclovir (assigned\nOR = 1.00). Recurrent antigenemia by day 180 after clearance of the initial CMV episode occurred in 34/61 (56 %) of\npatients. Using the multivariate model adjusting for the same covariates, there were also no significant differences\nin secondary episodes of CMV between treatment groups. With regards to adverse effect monitoring, Foscarnet led\nto significantly increased creatinine levels (P = 0.009), while Valganciclovir led to significant decrease in neutrophil\ncounts (P = 0.012).\nConclusion: High dose Valacyclovir is a potential alternative to Valganciclovir and Foscarnet in the stable post-HSCT\npatient who has cytopenia and is not keen for inpatient treatment of CMV antigenemia.
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