title: Unusual infections following allogeneic bone marrow transplantation for chronic lymphocytic leukemia.
abstract: Unusually severe infections phenomena were observed in three patients with chronic lymphocytic leukemia (CLL) who had undergone allogeneic bone marrow transplantation (BMT) from matched sibling donors. The first developed three episodes of cytomegaloviremia requiring anti-viral therapy; the third episode accompanied by cytomegalovirus hepatitis which required prolonged therapy with foscarnet. Another had Listeria monocytogenes meningitis which was difficult to eradicate and required prolonged maintenance antimicrobial therapy with oral trimethoprim-sulfamethoxazole and intrathecal gentamicin until death due to chronic graft-versus-host disease. The third patient had cytomegaloviremia lasting 47 days, which did not clear within 4 weeks of full-dose ganciclovir. Although the number of patients is small, in our experience the problems encountered were unusually severe compared with patients allografted for other disease. We conclude that CLL patients undergoing allogeneic BMT may be at a higher risk of infectious complications than patients allografted for other diseases, and require careful monitoring.
authors.affiliation: Royal Marsden Hospital, Surrey, UK.
authors.forename: A
authors.initials: A
authors.lastname: Zomas
authors.forename: J
authors.initials: J
authors.lastname: Mehta
authors.forename: R
authors.initials: R
authors.lastname: Powles
authors.forename: J
authors.initials: J
authors.lastname: Treleaven
authors.forename: T
authors.initials: T
authors.lastname: Iveson
authors.forename: S
authors.initials: S
authors.lastname: Singhal
authors.forename: B
authors.initials: B
authors.lastname: Jameson
authors.forename: B
authors.initials: B
authors.lastname: Paul
authors.forename: S
authors.initials: S
authors.lastname: Brincat
authors.forename: D
authors.initials: D
authors.lastname: Catovsky
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000209:etiology; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use; D015774:Ganciclovir / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000209:etiology; D006525:Hepatitis, Viral, Human / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000276:immunology / Q000628:therapy*; D008297:Male; D008584:Meningitis, Listeria / Q000188:drug therapy / Q000209:etiology; D008875:Middle Aged; D009894:Opportunistic Infections / Q000188:drug therapy / Q000209:etiology*; D014184:Transplantation, Homologous; D014766:Viremia / Q000188:drug therapy / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents; D017245:Foscarnet; D015774:Ganciclovir