• Patient compliance with an oral ganciclovir (GCV) regimen following induction with IV GCV as measured by a self-recorded patient diary and number of adverse events
  

• Observation of cytomegalovirus (CMV) in blood as measured by either blood culture or polymerase chain reaction (PCR) during the course of antiviral treatment
  
• Rate of CMV-associated disease that occurs during or after treatment
  
• Rate of CMV blood infection that occurs after treatment and during the period to day 180
  
• GCV blood levels
  
• Correlation of the GCV pharmacokinetic data with clinical outcome
  
• Practical ability to utilize PCR-based decisions
  

OBJECTIVES:

• To determine the feasibility of using oral ganciclovir (GCV) following induction with intravenous GCV in the setting of cytomegalovirus (CMV) reactivation after bone marrow transplantation.
• To evaluate the clearance of CMV as measured by quantitative plasma polymerase chain reaction (PCR) using this schema of treatment.
• To establish the feasibility of measuring steady state GCV blood levels in patients on oral GCV.
• To correlate GCV pharmacokinetic data with clinical outcome of these patients.
• To explore the feasibility of a CMV management guideline that incorporates PCR results in clinical decision making.

OUTLINE: Blood cultures for cytomegalovirus (CMV) are obtained periodically after the planned bone marrow transplantation (BMT). Patients showing reactivation of CMV receive induction ganciclovir (GCV) IV twice a day on days 1-7. Patients then receive maintenance oral GCV three times a day for 5 weeks in the absence of disease progression or unacceptable toxicity.

Patients undergo blood collection periodically during study for pharmacokinetic studies.