title: Fatal CMV pneumonia associated with steroid therapy after autologous transplantation in patients previously treated with fludarabine.
abstract: Fludarabine has been associated with an increased risk of opportunistic infections, possibly related to the induction of profound CD4+ lymphopenia. We observed two cases of cytomegalovirus pneumonia (CMV-IP) in a total of nine patients over a 5-year period who had previously received fludarabine and who proceeded to autografting. Both patients also received steroids post-transplant. CMV-IP was observed in one of 104 other autograft recipients over this time who had not received prior fludarabine. This observation suggests that the combination of fludarabine pre-transplant and steroids post-transplant may increase the risk of invasive CMV disease in autograft recipients.
authors.affiliation: Department of Clinical Haematology and Medical Oncology, Royal Melbourne Hospital, Victoria, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Grigg
authors.forename: R
authors.initials: R
authors.lastname: Chapman
authors.forename: J
authors.initials: J
authors.lastname: Szer
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000209:etiology*; D004317:Doxorubicin / Q000627:therapeutic use; D004357:Drug Synergism; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy; D008297:Male; D011024:Pneumonia, Viral / Q000209:etiology*; D011239:Prednisolone / Q000009:adverse effects*; D011241:Prednisone / Q000627:therapeutic use; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014740:Vidarabine / Q000009:adverse effects / Q000031:analogs & derivatives*; D014750:Vincristine / Q000627:therapeutic use; D019562:Viral Load
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D014740:Vidarabine; C024352:fludarabine; D011241:Prednisone