Clinical and genotypic CMV drug resistance in HSCT recipients: a single center epidemiological and clinical data
Abstrakt
We analysed the incidence, risk factors and the association between the treatment failure and viral resistance among 58 patients after allogeneic HSCT, who were treated for CMV reactivation/disease. The treatment failure (defined as a stable or increasing DNA viral load after 2 weeks of treatment) occurred in 9 patients (15.5%).
The presence of ganciclovir-resistant CMV strain was proved in three of them (mutations L595F, M460I and A594V detected by nucleotide sequence analysis of the UL97 and UL54). The median time of treatment failure diagnosis was 70 days after HSCT.
Patients with treatment failure were treated for a longer cumulative time than the patients susceptible to administrated virostatics (median of 90 vs 39 days, p = 0.003) and had a higher viral load peak (41,400 vs 4,160 cp/ml, p = 0.005). The viral load at the start of maintenance therapy was also higher (median of 1,305 vs 437 cp/ml, p = 0.0173) and the CMV disease occurred more often (p = 0.0152).
Patients with prolonged CMV replication, virostatic therapy and high viral load should be monitored closely and testing of viral sensitivity to virostatic treatment should be performed in cases of suspected treatment failure.