Late cytomegalovirus pneumonia in adult allogeneic blood and marrow transplant recipients.
To assess the impact of antiviral prophylaxis during the first 3 months after transplantation on the frequency, timing, and outcome of cytomegalovirus (CMV) pneumonia during the first year, 541 adult allogeneic blood and marrow transplant recipients were evaluated. Thirty-four patients (6.3%) developed 35 episodes of CMV pneumonia at a mean of 188 days after transplantation, with an associated mortality rate of 76%. Twenty-six episodes (74%) occurred late (after day 100). Of the patients with late CMV pneumonia almost all (92%) had chronic graft vs. host disease or had received T cell-depleted transplants. Fourteen late CMV pneumonias (54%) were associated with serious concurrent infections, and 100% of these episodes were fatal. In conclusion, although the frequency of CMV pneumonia in the early posttransplantation period may be substantially reduced by prophylaxis, CMV continues to be a major cause of morbidity and mortality in the late period. Some subsets of patients need more prolonged surveillance and prophylaxis and/or preemptive therapy.
Nguyen
Q
Q
Department of Medical Specialties, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Champlin
R
R
Giralt
S
S
Rolston
K
K
Raad
I
I
Jacobson
K
K
Ippoliti
C
C
Hecht
D
D
Tarrand
J
J
Luna
M
M
Whimbey
E
E
D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D003586:Cytomegalovirus Infections / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use; D015774:Ganciclovir / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011024:Pneumonia, Viral / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000998:Antiviral Agents; D017245:Foscarnet; D015774:Ganciclovir