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Alejo Erice, MD; M. Colin Jordan, MD; Beverly A. Chace, RN; Courtney Fletcher, PharmD; Barbara J. Chinnock, MT; Henry H. Balfour, Jr, MD

JAMA. 1987;257(22):3082-3087.

Abstract
Thirty-one immunocompromised patients with severe cytomegalovirus (CMV) disease were treated with intravenous ganciclovir. Twenty-one patients had received transplants—15 bone marrow recipients, five renal allograft recipients, and one liver transplant recipient—while the other ten were immunocompromised due to acquired immunodeficiency syndrome (six), hematologic malignancies (three), and systemic lupus erythematosus (one). They presented with one or more of the following syndromes: CMV pneumonitis (19), CMV of the gastrointestinal tract (six), CMV retinitis (seven), and CMV hepatitis (three). Seventeen (55%) of 31 patients demonstrated clinical improvement during ganciclovir therapy, with the best response seen in the transplant recipients. Viremia ceased in 14 (93.3%) of 15 patients after a mean of 4.7 days of therapy; viruria ceased in eight (53.3%) of 15 patients after a mean of 11 days of therapy. Ganciclovir plasma concentrations at a dosage of 2.5 mg/kg/three times a day were as follows: mean peak, 16.04 µmol/L; mean trough, 2.38 µmol/L. Neutropenia occurred in 11 (35%) of 31 patients and in nine (60%) of 15 bone marrow transplant recipients. We conclude that ganciclovir exerted an antiviral effect against CMV and may play a role in the treatment of CMV disease in patients with depressed immunity, especially bone marrow and organ transplant recipients.

(JAMA 1987;257:3082-3087

Author Affiliations
From the University of Minnesota Health Sciences Center, Minneapolis.

Footnotes
Reprint requests to Box 437 UMHC, University of Minnesota, Minneapolis, MN 55455 (Dr Balfour).

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