title: Use of cytomegalovirus intravenous immune globulin for the adjunctive treatment of cytomegalovirus in hematopoietic stem cell transplant recipients.
abstract: OBJECTIVE
  To describe the characteristics and clinical outcomes of hematopoietic stem cell transplant (HSCT) recipients who received adjunctive cytomegalovirus intravenous immune globulin (CMV-IVIG) for probable or proven CMV disease.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Large, university-affiliated, tertiary-care medical center.
  
  
  METHODS
  Thirty-five adult HSCT recipients who received at least one dose of CMV-IVIG for adjunctive treatment of probable or proven CMV disease between January 1, 1999, and December 31, 2007.
  
  
  RESULTS
  All-cause mortality at hospital discharge was the primary outcome. All patients received an allogeneic HSCT. Twenty-six patients (74%) had pneumonitis, nine (26%) had enteritis, and 29 (83%) had CMV viremia. All patients received concomitant antiviral therapy; 31 (89%) received ganciclovir, and 14 (40%) received foscarnet. All-cause mortality at hospital discharge was 49% (17 patients). Patient characteristics associated with mortality included requiring intubation for CMV pneumonia (11 [79%] of 14 nonsurvivors vs 3 (25%) of 12 survivors, p=0.016) and earlier disease onset after HSCT (median 48 days for nonsurvivors vs 106 days for survivors, p<0.001). In the multivariate analysis, only requiring intubation for CMV pneumonia remained a significant risk factor for increased mortality. A low rate of adverse events was attributed to CMV-IVIG, with mild hypertension (two patients [6%]) and erythema and chills (one patient [3%]) being the most common.
  
  
  CONCLUSIONS
  The mortality rate in our study population was similar to previous reports in the literature and may be somewhat lower than rates reported with antiviral monotherapy. Our analysis suggests that factors associated with mortality include the need for intubation and, possibly, earlier onset of CMV disease after HSCT. Treatment with CMV-IVIG appears to be well tolerated in HSCT recipients. These findings support further trials of CMV-IVIG efficacy in this setting.
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Alexander
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Hladnik
authors.forename: Kristan M
authors.initials: KM
authors.lastname: Augustin
authors.forename: Ed
authors.initials: E
authors.lastname: Casabar
authors.forename: Peggy S
authors.initials: PS
authors.lastname: McKinnon
authors.forename: Richard M
authors.initials: RM
authors.lastname: Reichley
authors.forename: David J
authors.initials: DJ
authors.lastname: Ritchie
authors.forename: Peter
authors.initials: P
authors.lastname: Westervelt
authors.forename: Erik R
authors.initials: ER
authors.lastname: Dubberke
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage / Q000627:therapeutic use*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male
chemical_list: D000276:Adjuvants, Immunologic; D000998:Antiviral Agents; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; C045781:cytomegalovirus-specific hyperimmune globulin