Fatal CMV pneumonia associated with steroid therapy after autologous transplantation in patients previously treated with fludarabine.
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.
Grigg
A
A
Department of Clinical Haematology and Medical Oncology, Royal Melbourne Hospital, Victoria, Australia.
Chapman
R
R
Szer
J
J
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
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D014740:Vidarabine; C024352:fludarabine; D011241:Prednisone