Infection
Conditions
Keywords
infection
Brief summary
RATIONALE: Antivirals such as valganciclovir act against viruses and may be effective in preventing cytomegalovirus. It is not yet known if valganciclovir is effective in preventing cytomegalovirus. PURPOSE: This randomized phase III trial is studying valganciclovir to see how well it works in preventing cytomegalovirus in patients who have undergone donor stem cell transplantation.
Detailed description
OBJECTIVES: Primary * Compare cytomegalovirus (CMV) disease and non-CMV invasive infection-free survival in patients undergoing allogeneic hematopoietic stem cell transplantation treated with valganciclovir vs placebo. * Compare the incidence of CMV disease in patients treated with these drugs. * Compare the incidence of other severe invasive bacterial and fungal infections and overall survival in patients treated with these drugs. Secondary * Compare the incidence of CMV infection or disease at baseline and at days 270 and 640 after allogeneic hematopoietic stem cell transplantation in patients treated with these drugs. * Compare the incidence of herpes simplex virus and varicella-zoster virus infections at baseline and day 270 in patients treated with these drugs. * Determine the safety of valganciclovir in these patients. * Compare the quality of life of patients treated with these drugs. * Compare CMV-specific immune reconstitution in patients treated with these drugs. OUTLINE: This is a randomized, double-blind, placebo-controlled, multicenter study. Patients are stratified according to participating center, prior neutropenia (yes vs no), and presence of refractory graft-versus-host disease requiring secondary therapy (yes vs no). Patients are randomized to 1 of 2 treatment arms. * Arm I: Patients receive oral valganciclovir daily. * Arm II: Patients receive oral placebo daily. Treatment begins around day 80-120 post-transplantation and continues until day 270 post-transplantation in the absence of active infection or unacceptable toxicity. Patients developing active cytomegalovirus (CMV) infection receive induction doses of ganciclovir IV or open-label oral valganciclovir for 1 week followed by open-label oral valganciclovir maintenance dosing until CMV can no longer be detected. Quality of life is assessed at baseline and days 180 and 270 post-transplantation. Patients are followed at days 400, 520, and 640 post-transplantation. PROJECTED ACCRUAL: A total of 184 patients (92 per treatment arm) will be accrued for this study.
Interventions
DRUGganciclovir
DRUGvalganciclovir
Sponsors
National Cancer Institute (NCI)
Fred Hutchinson Cancer Center
Study design
Allocation
RANDOMIZED
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE
Eligibility
Sex/Gender
ALL
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
DISEASE CHARACTERISTICS: * Have undergone allogeneic peripheral blood stem cell, cord blood, or marrow transplantation (related or unrelated, T-cell depleted or non-T-cell depleted, CD34-selected or non-selected, or myeloablative or non-myeloablative) within the past 80-120 days * Positive pre-transplantation cytomegalovirus (CMV) serology of recipient and/or donor * Seropositive recipients with one of the following: * CMV infection before day 80, as determined by: * pp65 antigenemia * CMV DNA in plasma * Peripheral blood leukocytes (PBL) or whole blood at any level detected by polymerase chain reaction or hybrid capture * CMV pp67 mRNA * CMV viremia by blood culture * Surveillance bronchoalveolar lavage (culture or cytology) * CMV disease more than 6 weeks prior to enrollment * Presence of graft-versus-host disease (GVHD) at enrollment * Acute GVHD that requires treatment with systemic corticosteroids of doses greater than 0.5 mg/kg OR * Chronic clinically extensive GVHD requiring treatment with corticosteroids * Continuous prophylaxis with ganciclovir, foscarnet, or cidofovir between engraftment and day 80 OR * Seronegative recipient with seropositive donor who has CMV infection before day 80 * No rising or uncontrolled CMV load (pp65 antigenemia levels no greater than 1/slide or no greater than 100 copies of CMV DNA per mL of plasma or per million PBL allowed) * No CMV disease within 6 weeks prior to randomization * No leukemic relapse * Cytogenetic or molecular relapse allowed PATIENT CHARACTERISTICS: Age: * 16 and over Performance status: * Not specified Life expectancy: * At least 2 weeks Hematopoietic: * Absolute neutrophil count at least 1,000/mm\^3 for at least 1 week prior to enrollment Hepatic: * Not specified Renal: * Creatinine no greater than 2.5 mg/mL Other: * No hypersensitivity to ganciclovir or valganciclovir * No uncontrolled diarrhea or severe gastrointestinal disease that would preclude oral medication * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception during and for 90 days after study participation * HIV negative * Proficient in English PRIOR CONCURRENT THERAPY: Biologic therapy: * See Disease Characteristics Chemotherapy: * Not specified Endocrine therapy: * See Disease Characteristics Radiotherapy: * Not specified Surgery: * Not specified Other: * Prior ganciclovir, foscarnet, cidofovir, high-dose acyclovir, or valacyclovir as prophylaxis or preemptive therapy allowed * No concurrent prophylactic foscarnet, cidofovir, or ganciclovir (IV or oral) * No concurrent prophylactic high-dose acyclovir (more than 800 mg twice daily), valacyclovir (more than 500 mg twice daily), cidofovir (more than 0.5 mg/kg per week), or famciclovir (more than 500 mg/day) except for limited treatment courses at higher doses for varicella-zoster virus infections * Concurrent low-dose (≤ 0.5 mg/kg per week) cidofovir allowed for limited treatment courses
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Late cytomegalovirus infection by plasma PCR positivity | — |
Countries
United States
Outcome results
None listed