Taming the Transplantation Troll by Targeting Terminase  

Oleh:

Griffiths, Paul D. ; Emery, Vincent C.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 370 no. 19 (May 2014), page 1844-1846.

Ketersediaan

Perpustakaan FK Nomor Panggil: N08.K.2014.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

The immunosuppressive drugs required after stem-cell transplantation render patients susceptible to opportunistic infections. The most important of these infections, in terms of both abundance and severity, is cytomegalovirus (CMV), which has been dubbed the “troll of transplantation.”1 Fortunately, the clinical effects of CMV infection have been reduced by preemptive therapy. Levels of CMV DNA in the blood (viremia) are monitored with the use of polymerase-chain-reaction (PCR) assays and, if viremia is detected, patients receive ganciclovir (or its prodrug valganciclovir) until viral DNA is no longer detectable.2 In addition to controlling overt CMV end-organ disease, since these agents are used only if viremia is detected, this strategy minimizes the bone marrow toxicity of ganciclovir and valganciclovir, which is clinically highly important after stem-cell transplantation.2 After solid-organ transplantation, these agents can be administered prophylactically with efficacy and safety that are similar to those of preemptive therapy.3,4 For patients who have undergone transplantation, drugs with reduced toxicity, improved potency, or both, as compared with ganciclovir and valganciclovir, are highly desirable. An appropriate study design2 in a placebo-controlled trial is to administer the experimental drug prophylactically and determine whether selected doses, as compared with placebo (the standard of care), can reduce the need for preemptive therapy.

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