CMV pneumonia in allogeneic BMT recipients undergoing early treatment of pre-emptive ganciclovir therapy.
The incidence, treatment and outcome of CMV interstitial pneumonia (CMV-IP) were reviewed in 139 consecutive allogeneic BMT patients undergoing extended CMV antigenemia surveillance and two different ganciclovir (GCV) strategies to control CMV infection. Nineteen cases of CMV-IP were reviewed, 16 of 63 patients (25.4%) who received early GCV treatment (ET) and three of 76 patients (3.9%) who received preemptive (PE) GCV therapy. In the ET group, the median time for occurrence of CMV-IP was 55 (range 36 to 311) days. Two patients had three episodes of CMV-IP recurrences after day +100. CMV-IP-related death occurred in two patients (15.4%). In the PE group, 41 patients received pre-emptive GCV therapy prompted by the appearance of positive antigenemia > or =2 cells. The median time for the occurrence of CMV-IP was 92 (range 48 to 197) days. Response to therapy was observed when GCV was introduced within 6 days of antigenemia positivity. The use of IVIg in association with GCV did not play a major role in response to therapy. The median time for occurrence of CMV-IP was delayed during PE strategy and the cost-effectiveness of CMV surveillance after day +100 should be investigated in this population.
Machado
C M
CM
BMT Program, Fundação Pró Sangue Hemocentro de São Paulo, Discipline of Hematology, Brazil.
Dulley
F L
FL
Boas
L S
LS
Castelli
J B
JB
Macedo
M C
MC
Silva
R L
RL
Pallota
R
R
Saboya
R S
RS
Pannuti
C S
CS
D000293:Adolescent; D000328:Adult; D000956:Antigens, Viral / Q000378:metabolism; D000998:Antiviral Agents / Q000008:administration & dosage / Q000592:standards; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D004359:Drug Therapy, Combination; D015774:Ganciclovir / Q000008:administration & dosage* / Q000592:standards; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000592:standards; D015994:Incidence; D017563:Lung Diseases, Interstitial / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D008875:Middle Aged; D011024:Pneumonia, Viral / Q000188:drug therapy* / Q000453:epidemiology; D011292:Premedication; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome
D000956:Antigens, Viral; D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D015774:Ganciclovir