Clinical impact of neutropenia related with the preemptive therapy of CMV infection in solid organ transplant recipients

Summary Objectives The most frequent adverse events associated with valganciclovir treatment are hematological disturbances such as neutropenia. However, the consequences of neutropenia are unknown. We investigated the clinical impact of neutropenia during CMV preemptive therapy and its relationship with the length of antiviral therapy. Methods An observational, prospective cohort of 67 solid organ transplant recipients receiving CMV preemptive therapy was studied. Results Severe neutropenia occurred in 21.8% of the patients at a median of three weeks after initiating antiviral therapy. No association was observed between neutropenia and infection risk in these patients. Liver transplant recipients had 6.7 fold increased risk of neutropenia during CMV therapy compared to kidney transplant recipients ( p = 0.012). Patients who developed severe neutropenia received antiviral therapy a median of six days longer than patient who did not ( p = 0.457). Conclusions Despite the frequency of neutropenia during CMV preemptive therapy, the incidence of infections is not increased. Adjusting the length of preemptive therapy during the episodes of viremia may be recommended, especially in patients with concurrent risk factors for neutropenia such as liver recipients. Further trials are warranted to confirm the safety of this approach.