Evaluation of valganciclovir's neutropenia risk in pediatric solid organ transplant recipients utilizing two dosing
Avani Patel1, Kevin Le2, Natalia Panek2
1The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
The Pescovitz algorithm for valganciclovir dosing in pediatric transplant recipients led to higher neutropenia rates compared to weight-based dosing. Cytomegalovirus infection rates remained similar between the two dosing methods.
Area of Science:
- Pediatric Transplant Medicine
- Pharmacology
- Infectious Diseases
Background:
- Valganciclovir is used for cytomegalovirus (CMV) prophylaxis in pediatric patients.
- The Pescovitz algorithm, commonly used for dosing, has been linked to overdoses in children with low body surface area.
- Overestimations in creatinine clearance can occur with the Pescovitz algorithm.
Purpose of the Study:
- To compare the incidence of neutropenia and CMV infection between Pescovitz and weight-based valganciclovir dosing algorithms in pediatric transplant recipients.
- To evaluate the safety and efficacy of different valganciclovir dosing strategies.
Main Methods:
- A retrospective chart review of 187 pediatric heart, liver, and kidney transplant recipients who received valganciclovir.
- Data collected from January 2010 to September 2018.
- Primary endpoint: incidence of neutropenia; secondary endpoint: incidence of CMV infection.
Main Results:
- The incidence of neutropenia was significantly higher in the Pescovitz group (69.4%) compared to the weight-based group (53.6%; p=0.04).
- Moderate and severe neutropenia were more frequent with the Pescovitz algorithm.
- No significant difference in CMV viremia or disease was observed between the two groups (Pescovitz: 4.8% vs. weight-based: 2.4%; p=0.4).
Conclusions:
- Valganciclovir dosing via the Pescovitz algorithm resulted in a greater incidence of neutropenia in pediatric transplant recipients.
- Weight-based dosing appears to be a safer alternative regarding neutropenia.
- Current dosing algorithms do not significantly impact CMV infection rates, but neutropenia risk differs.
Background:
Valganciclovir is approved for cytomegalovirus prophylaxis in pediatrics using the Pescovitz algorithm. There are reports of valganciclovir overdoses in children with low body surface area and overestimated creatinine clearance utilizing this algorithm. This study compared the incidence of neutropenia and cytomegalovirus infection between the Pescovitz and weight-based dosing algorithms.
Methods:
A single-center retrospective chart review from January 2010 to September 2018 was performed on pediatric heart, liver, and kidney transplant recipients, who received valganciclovir. Data were collected from the initiation of valganciclovir prophylaxis to 30 days after discontinuation. The primary objective was the incidence of neutropenia in patients receiving valganciclovir dosed by the Pescovitz versus weight-based dosing algorithms.
Results:
This study included 187 pediatric transplant recipients who received valganciclovir dosed via the Pescovitz (62 recipients) or weight-based dosing algorithms (125 recipients). The incidence of neutropenia was higher in the Pescovitz (69.4%) compared to the weight-based dosing group (53.6%; p = .04) including moderate and severe neutropenia. Cytomegalovirus viremia was not significantly different between the two groups and occurred in 4.8% of the Pescovitz group compared to 2.4% of the weight-based group (p = .4).
Conclusions:
The incidence of neutropenia was greater in recipients receiving valganciclovir dosed via the Pescovitz algorithm compared to the weight-based dosing. There were no significant differences in regard to cytomegalovirus viremia or disease between the two groups.
More Related Videos
10:24Automated Cell Enrichment of Cytomegalovirus-specific T cells for Clinical Applications using the Cytokine-capture System
Published on: October 5, 2015
06:08Assessment of Chimeric Antigen Receptor T Cell-Associated Toxicities Using an Acute Lymphoblastic Leukemia Patient-Derived Xenograft Mouse Model
Published on: February 10, 2023
