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Acquired resistance and lack of efficacy in cytomegalovirus reactivation: 14 case reports In a retrospective study (patients treated in Spain over a period of 5 years 2009–2013), 14 adult patients including three men [exact ages not stated; not all sexes stated] were described, of whom three patients acquired resistance during treatment with ganciclovir or valganciclovir for cytomegalovirus (CMV) reactivation. The remaining 11 patients exhibited lack of efficacy with ganciclovir, valganciclovir or foscarnet for CMV reactivation. The patients had undergone allogeneic haematopoietic cell transplantation with aciclovir [acyclovir] prophylaxis. Following transplantation, the patients were found to have developed CMV reactivation. Therefore, the patients started receiving IV ganciclovir with induction dose at 5 mg/kg every 12 hours followed by maintenance dose at 6 mg/kg/day (6 patients), oral valganciclovir with induction dose at 900 mg/12 hours followed by maintenance dose at 900 mg/day (5 patients), and IV ganciclovir with induction dose at 5 mg/kg every 12 hours followed by maintenance dose at 6 mg/kg/day as well as oral valganciclovir with induction dose at 900 mg/12 hours followed by maintenance dose at 900 mg/day (3 patients). Four of the 14 patients additionally received second-line therapy with IV foscarnet with induction dose at 60 mg/kg/12 hours followed by maintenance dose at 90 mg/kg/day. Eleven of the 14 patients’ condition was refractory, indicating lack of efficacy with ganciclovir, valganciclovir or foscarnet. The remaining three patients were found to have developed A594V resistance mutation (2 patients) and H520Q resistance mutation (1 patient), indicating acquired resistance to ganciclovir or valganciclovir (CMV resistance). Therapy of the three patients, who developed resistance, was switched to foscarnet or cidofovir. Subsequently, these three patients died of respiratory failure (2 patients) and neutropenia (1 patient). Additionally, four of the remaining 11 patients died [immediate causes of deaths not stated]. Guiu A, et al. Study of cytomegalovirus resistance in allogeneic hematopoietic cell transplant recipients. Medicina Clinica 154: 433-439, No. 11, 12 Jun 2020. Available from: 803501248 URL: http://doi.org/10.1016/j.medcli.2019.07.027 [Spanish; summarised from a translation]

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Reactions 19 Sep 2020 No. 1822