title: Cytomegalovirus pneumonia after bone marrow transplantation successfully treated with the combination of ganciclovir and high-dose intravenous immune globulin.
abstract: 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.
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: D
authors.initials: D
authors.lastname: Emanuel
authors.forename: I
authors.initials: I
authors.lastname: Cunningham
authors.forename: K
authors.initials: K
authors.lastname: Jules-Elysee
authors.forename: J A
authors.initials: JA
authors.lastname: Brochstein
authors.forename: N A
authors.initials: NA
authors.lastname: Kernan
authors.forename: J
authors.initials: J
authors.lastname: Laver
authors.forename: D
authors.initials: D
authors.lastname: Stover
authors.forename: D A
authors.initials: DA
authors.lastname: White
authors.forename: A
authors.initials: A
authors.lastname: Fels
authors.forename: B
authors.initials: B
authors.lastname: Polsky
mesh_terms: 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
chemical_list: D015774:Ganciclovir; D000212:Acyclovir