Frequently asked questions about ganciclovir

In the Princess Máxima Center, ganciclovir is given to about 10 children per year.

Ganciclovir is used to treat or prevent infections with the so-called CMV virus in children and adults who have had a stem cell or organ transplant. These patients have a reduced immune system, which means that a CMV infection can be life-threatening. Ganciclovir is also given to newborns born with CMV infections, and to patients who have low immunity for reasons other than transplantation and who develop a CMV infection.

Ganciclovir is used to treat or prevent serious infections with the CMV virus. Ganciclovir stops the CMV virus from multiplying.

Ganciclovir was patented in 1980, and was officially approved for use in patients in 1988.

The usual safety testing for new drugs was done in the development of ganciclovir. Tests in cultured cells and laboratory mice showed that ganciclovir can be harmful to DNA and in some cases can lead to cancer. However, the disease – cytomegalovirus, or CMV – is so many times worse than the drug ganciclovir, that it did get used. A link between ganciclovir and cancer risk has not previously been shown in people. Thanks to new techniques in science, it is now possible to analyze the entire DNA of tumors. By targeting the ganciclovir ‘DNA scar’ in tumors of thousands of patients, the researchers have now identified a small number of cancer cases likely caused by ganciclovir.

This study shows that treatment with ganciclovir leads to a specific 'scar' in the DNA of stem cells. The researchers found this same scar in cancers of patients who had been treated with ganciclovir earlier in their lives. Stem cells exposed to ganciclovir in the laboratory also develop this scar. This proves that ganciclovir is the cause of this DNA scar. Fortunately, damage to the DNA does not directly lead to cancer. Often several changes, in the DNA and in other parts of the cell, are needed to turn a healthy cell into a cancer cell.

There is no reason to adjust the protocols yet. Ganciclovir is one of the most effective drugs against CMV infections. These infections can be life-threatening after stem cell transplantation and must therefore be treated effectively. Although this research shows that ganciclovir may cause cancer, until now only a small number of tumors with the ganciclovir scar have been found. That's why more research is needed to assess how often, and in which patients, ganciclovir can lead to DNA damage and cancer.

Ganciclovir and foscarnet are both effective treatments against the CMV virus. Foscarnet is not tolerated long-term by most patients due to side effects. Ganciclovir is then the only alternative.

For information about the treatment of your child, please contact your child's doctor.

The most important long-term consequences of a stem cell transplant are related to the pre-transplant treatment with chemotherapy or radiation. And with any treatments that a child has had before. Because of all the treatments that a child with cancer has to undergo, there is a small chance that a new malignant disease will occur. Children in the Máxima are monitored for this and other late effects in the LATER outpatient clinic.

Ganciclovir is one of the most effective treatments against the CMV virus. There is currently no good alternative. If you are unsure about your child's treatment, you can discuss this with their doctor.

It is impossible to know for certain. There are many different factors that contribute to the development of cancer. More research is needed on how ganciclovir can cause cancer, and to what extent it can increase the risk of cancer.

A stem cell transplant is an intense and complex treatment. Patients are hospitalized for a long time and are treated with various medicines. There is usually not one specific part of the disease or treatment that directly or on its own causes a patient to die. This makes it difficult to answer whether ganciclovir caused a death.