Intravenous ganciclovir GCV, currently the recommended standard treatment for cytomegalovirus CMV disease in transplant recipients in India, requires hospitalization, often a central intravenous line, and thus is expensive and inconvenient for patients. A safe and effective oral therapy may significantly improve and simplify the management of posttransplant CMV disease. Oral VGCV showed comparable safety and was not inferior to intravenous GCV for treatment of CMV disease in organ transplant recipients and provided a simpler treatment strategy in a randomized, open-label, parallel-group, active drug-controlled, multi-center noninferiority trial at 42 centers including 326 patients. Adult solid organ transplant recipients with both virologic and clinical evidence of CMV disease, regardless of donor or recipient CMV serostatus were enrolled into this trial. Baseline viral loads were not different between groups. Side-effects and discontinuations of assigned treatment were comparable. The success rate at day 21 defined as a negative plasma polymerase chain reaction PCR, Roche Diagnostics, USA with a cut-off of 600 copies per mL for CMV was 45.1 percentage for VGCV and 48.4 percentage for GCV. Winston et al. studied the pharmacokinetics of VGCV and GCV in a cross-over design in adult patients after allogeneic stem cell transplantation with Graft-versus-Host Disease GVHD of the gastrointestinal tract and established noninferiority of VGCV. Data on pediatric patients after allogeneic HCT alloHCT are available from a phase II trial in which all patients first received GCV but some patients later on switched to the oral drug. Both treatments were equally effective. VGCV is not approved by European Medicines Agency EMA or U.S. Food and Drug Administration FDA for the pre-emptive treatment of CMV reactivations in pediatric patients following alloHCT but still is common practice in many experienced centers. Therefore, this trial aims at demonstrating safety and efficacy of VGCV for the pre-emptive treatment of pediatric patients with CMV reactivation after alloHCT.