Treatment of severe cytomegalovirus infection with ganciclovir and high-dose intravenous immunoglobulin in patients with allogeneic bone marrow transplants. A pilot study.
Cytomegalovirus (CMV) infection is the leading infectious cause of death after bone marrow transplantation (BMT) because of the high mortality rate associated with CMV pneumonia. However, very interresting results were recently reported when treating CMV penumonia with the combination of ganciclovir and high doses of intravenous anti-CMV immunoglobulin. In order to achieve an even better therapeutic efficacy, we have conducted a pilot study consisting of early administration of the combination therapy, as soon as CMV was isolated from the material obtained by bronchoalveolar lavage (BAL). A BAL was performed when symptoms of severe CMV infection were present and sometimes also systematically when an asymptomatic CMV viremia was diagnosed. Out of 18 BMT patients with CMV isolated from BAL in the absence of pulmonary signs, 9 became long-term survivors without any episode of CMV pneumonia and 9 died. However, only 2 patients died because of CMV pneumonia. Early treatment with the combination of ganciclovir and anti CMV immunoglobulin seems thus to decrease the incidence of CMV pneumonia (2/18) as it is known that about half of the untreated patients with CMV viremia will develop CMV pneumonia. We have also used the combination therapy to treat 3 cases of CMV pneumonia. As 2 patients survived the CMV pneumonia episode, this confirms the possible effectiveness of the combination therapy for the treatment of established CMV pneumonia. However, our pilot study points out the usefulness of an early treatment. At such an early stage, application of the combination therapy could affect the intensity and length of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
Lehn
P
P
Unité Fonctionnelle de Greffe de Moelle, Hôpital Saint-Louis, Paris, France.
Quessar
A
A
Devergie
A
A
Esperou-Bourdeau
H
H
Traineau
R
R
Trédaniel
J
J
Benbunan
M
M
Bussel
A
A
Jolivet
I
I
Mazeron
M C
MC
D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D003131:Combined Modality Therapy; D003586:Cytomegalovirus Infections / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D007116:Immunization, Passive; D007275:Injections, Intravenous; D010865:Pilot Projects; D015996:Survival Rate; D014184:Transplantation, Homologous
D015774:Ganciclovir