title: Should cytomegalovirus be tested for in both blood and bronchoalveolar lavage fluid of patients at a high risk of CMV pneumonia after bone marrow transplantation?
abstract: To identify and treat patients at high risk of cytomegalovirus (CMV) pneumonia after bone marrow transplantation (BMT), we tested for CMV viraemia weekly, and performed broncho-alveolar lavage (BAL) on day 35 post-transplant in 63 recipients. 36 allogeneic BMT recipients were at a high risk of CMV pneumonia (25 CMV-seropositive recipients and 11 patients receiving marrow from a CMV-seropositive donor). Patients with a positive BAL or viraemia received a 14 d course of ganciclovir or foscarnet. CMV was detected in 29 (46%) of the 63 BMT recipients and excretion of CMV in blood and BAL was significantly linked. However, among the 29 patients who excreted the virus, only 10 (35%) shed CMV in blood and BAL at the same time: 19 patients (65%) had detectable CMV in blood (11 patients) or BAL (eight patients) only. Therefore, on the basis of viraemia or BAL alone, 21/29 patients (70%) and 18/29 patients (60%), respectively, would have received antiviral treatment. BAL increased the CMV detection rate by 13% (8/63 patients) relative to viraemia. With this strategy, the incidence of CMV pneumonia was reduced to 3% in allografted patients. Only two of the 19 autografted patients developed fatal CMV pneumonia. We avoided anti-CMV treatment in 54% of all the BMT recipients. In conclusion, CMV should be tested for in both blood and BAL fluid of BMT recipients at high risk of CMV pneumonia.
authors.affiliation: Pathology Department, Institut Gustave Roussy, Villejuif, France.
authors.forename: A
authors.initials: A
authors.lastname: Ibrahim
authors.forename: E
authors.initials: E
authors.lastname: Gautier
authors.forename: S
authors.initials: S
authors.lastname: Roittmann
authors.forename: J H
authors.initials: JH
authors.lastname: Bourhis
authors.forename: A
authors.initials: A
authors.lastname: Fajac
authors.forename: I
authors.initials: I
authors.lastname: Charnoz
authors.forename: P
authors.initials: P
authors.lastname: Terrier
authors.forename: J M
authors.initials: JM
authors.lastname: Salord
authors.forename: C
authors.initials: C
authors.lastname: Tancrède
authors.forename: M
authors.initials: M
authors.lastname: Hayat
authors.forename: J F
authors.initials: JF
authors.lastname: Bernaudin
authors.forename: J L
authors.initials: JL
authors.lastname: Pico
mesh_terms: D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology*; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007938:Leukemia / Q000628:therapy; D008223:Lymphoma / Q000628:therapy; D008297:Male; D009894:Opportunistic Infections / Q000175:diagnosis*; D011024:Pneumonia, Viral / Q000175:diagnosis*; D012307:Risk Factors; D014766:Viremia / Q000175:diagnosis