Cytomegalovirus pneumonia after bone marrow transplantation successfully treated with the combination of ganciclovir and high-dose intravenous immune globulin.
OBJECTIVE
To assess the efficacy of the combination of the antiviral agent ganciclovir (9-1,3 dihydroxy-2-propoxymethylguanine) and high-dose intravenous immune globulin for treating cytomegalovirus interstitial pneumonitis after allogeneic bone marrow transplantation.


METHODS
Nonrandomized prospective trial of combined treatment with two drugs; findings in these patients were compared with those in control patients treated with either of the two drugs alone.


METHODS
Medical, pediatric, and intensive care units of a tertiary-care cancer treatment center.


METHODS
Consecutive cases of 10 patients in the study group and of 11 patients in a historical control group with evidence of cytomegalovirus pneumonia after bone marrow transplantation for treatment of leukemia or congenital immune deficiency.


METHODS
Study Group (10 patients): ganciclovir, 2.5 mg/kg body weight, three times daily for 20 days, plus intravenous immune globulin, 500 mg/kg every other day for ten doses. Patients were then given ganciclovir, 5 mg/kg.d three to five times a week for 20 more doses, and intravenous immune globulin, 500 mg/kg twice a week for 8 more doses. Control Group (11 patients): ganciclovir alone (2 patients), 5 mg/kg twice a day for 14 to 21 days; cytomegalovirus hyperimmune globulin (5 patients), 400 mg/kg.d for 10 days; and intravenous immune globulin (4 patients), 400 mg/kg.d for 10 days.


RESULTS
Responses were observed in all patients treated with combination therapy; 7 of 10 patients were alive and well, and had no recurrence of disease at a median of 10 months after therapy. No therapeutic benefit was observed, and none of the 11 patients treated with either ganciclovir or intravenous immune globulin alone survived (P = 0.001 by Fisher exact test).


CONCLUSIONS
Ganciclovir, when combined with high-dose intravenous immune globulin, appears to have significantly altered the outcome of patients with cytomegalovirus pneumonia after allogeneic bone marrow transplantation.
Emanuel
D
D
Memorial Sloan-Kettering Cancer Center, New York, New York.
Cunningham
I
I
Jules-Elysee
K
K
Brochstein
J A
JA
Kernan
N A
NA
Laver
J
J
Stover
D
D
White
D A
DA
Fels
A
A
Polsky
B
B
D000212:Acyclovir / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D016026:Bone Marrow Transplantation; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D002648:Child; D003131:Combined Modality Therapy; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000382:microbiology / Q000628:therapy*; D005260:Female; D015774:Ganciclovir; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D007116:Immunization, Passive; D007223:Infant; D008264:Macrophages / Q000382:microbiology; D008297:Male; D011024:Pneumonia, Viral / Q000382:microbiology / Q000628:therapy*; D011183:Postoperative Complications / Q000382:microbiology / Q000628:therapy*; D011446:Prospective Studies; D011658:Pulmonary Fibrosis / Q000382:microbiology / Q000628:therapy
D015774:Ganciclovir; D000212:Acyclovir