Antiviral dosing for preemptive therapy in adult patients
| . | Induction preferred . | Induction alternative . | Maintenance preferred . | Maintenance alternative . |
|---|---|---|---|---|
| Pretransplant | ||||
| Through day −2 | Valganciclovir:* adults and children ≥50 kg body weight, 900 mg by mouth every 12 h, or ganciclovir, 5 mg/kg IV every 12 h | Foscarnet, 60 mg/kg IV every 12 h† | Valganciclovir: adults, 900 mg by mouth dailyGanciclovir, 5 mg/kg IV daily | Foscarnet, 90 mg/kg IV daily |
| After day −2 through day 0 | Foscarnet, 60 mg/kg IV every 12 h† | X | Foscarnet, 90 mg/kg IV daily | X |
| Prosttransplant | ||||
| Pre-engraftment‡ | Foscarnet, 60 mg/kg IV every 12 h† | X | Foscarnet, 90 mg/kg IV daily | X |
| Postengraftment | Valganciclovir or ganciclovir (see dosing guidelines above for pretransplant through day −2) | Foscarnet 60 mg/kg IV every 12 h† | Valganciclovir or ganciclovir (see dosing guidelines above for pretransplant through day −2) | Foscarnet, 90 mg/kg IV daily |
| . | Induction preferred . | Induction alternative . | Maintenance preferred . | Maintenance alternative . |
|---|---|---|---|---|
| Pretransplant | ||||
| Through day −2 | Valganciclovir:* adults and children ≥50 kg body weight, 900 mg by mouth every 12 h, or ganciclovir, 5 mg/kg IV every 12 h | Foscarnet, 60 mg/kg IV every 12 h† | Valganciclovir: adults, 900 mg by mouth dailyGanciclovir, 5 mg/kg IV daily | Foscarnet, 90 mg/kg IV daily |
| After day −2 through day 0 | Foscarnet, 60 mg/kg IV every 12 h† | X | Foscarnet, 90 mg/kg IV daily | X |
| Prosttransplant | ||||
| Pre-engraftment‡ | Foscarnet, 60 mg/kg IV every 12 h† | X | Foscarnet, 90 mg/kg IV daily | X |
| Postengraftment | Valganciclovir or ganciclovir (see dosing guidelines above for pretransplant through day −2) | Foscarnet 60 mg/kg IV every 12 h† | Valganciclovir or ganciclovir (see dosing guidelines above for pretransplant through day −2) | Foscarnet, 90 mg/kg IV daily |
X, no standard alternative.
Oral valganciclovir induction and/or maintenance therapy should be considered only for patients with good oral intake, no active severe gut GvHD, no significant liver disease, and no severe diarrhea.
At the Fred Hutchinson Cancer Research Center, foscarnet (90 mg/kg every 12 hours) is administered for induction.
Engraftment defined as stable absolute neutrophil count (ANC) >1000 for non–cord blood patients or stable ANC >2000 for cord blood patients, lasting for ≥3 days and maintained without G-CSF support.