title: Reduced Mortality of Cytomegalovirus Pneumonia After Hematopoietic Cell Transplantation Due to Antiviral Therapy and Changes in Transplantation Practices.
abstract: BACKGROUND
  Despite major advances in the prevention of cytomegalovirus (CMV) disease, the treatment of CMV pneumonia in recipients of hematopoietic cell transplant remains a significant challenge.
  
  
  METHODS
  We examined recipient, donor, transplant, viral, and treatment factors associated with overall and attributable mortality using Cox regression models.
  
  
  RESULTS
  Four hundred twenty-one cases were identified between 1986 and 2011. Overall survival at 6 months was 30% (95% confidence interval [CI], 25%-34%). Outcome improved after the year 2000 (all-cause mortality: adjusted hazard ratio [aHR], 0.7 [95% CI, .5-1.0]; P = .06; attributable mortality: aHR, 0.6 [95% CI, .4-.9]; P = .01). Factors independently associated with an increased risk of all-cause and attributable mortality included female sex, elevated bilirubin, lymphopenia, and mechanical ventilation; grade 3/4 acute graft-vs-host disease was associated with all-cause mortality only. An analysis of patients who received transplants in the current preemptive therapy era (n = 233) showed only lymphopenia and mechanical ventilation as significant risk factors for overall and attributable mortality. Antiviral treatment with ganciclovir or foscarnet was associated with improved outcome compared with no antiviral treatment. However, the addition of intravenous pooled or CMV-specific immunoglobulin to antiviral treatment did not seem to improve overall or attributable mortality.
  
  
  CONCLUSIONS
  Outcome of CMV pneumonia showed a modest improvement over the past 25 years. However, advances seem to be due to antiviral treatment and changes in transplant practices rather than immunoglobulin-based treatments. Novel treatment strategies for CMV pneumonia are needed.
authors.affiliation: Division of Vaccine and Infectious Disease Clinic of Medicine, Hôpital Fribourgeois Fribourg, Switzerland and.
authors.forename: Veronique
authors.initials: V
authors.lastname: Erard
authors.affiliation: Division of Clinical Research Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Guthrie
authors.affiliation: Division of Vaccine and Infectious Disease.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Seo
authors.affiliation: Division of Vaccine and Infectious Disease.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Smith
authors.affiliation: Department of Laboratory Medicine.
authors.forename: MeeiLi
authors.initials: M
authors.lastname: Huang
authors.affiliation: Division of Clinical Research.
authors.forename: Jason
authors.initials: J
authors.lastname: Chien
authors.affiliation: Division of Clinical Research Department of Medicine, University of Washington, Seattle.
authors.forename: Mary E D
authors.initials: ME
authors.lastname: Flowers
authors.affiliation: Division of Vaccine and Infectious Disease Department of Laboratory Medicine Department of Medicine, University of Washington, Seattle.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
authors.affiliation: Division of Vaccine and Infectious Disease Division of Clinical Research Department of Medicine, University of Washington, Seattle.
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D011024:Pneumonia, Viral / Q000188:drug therapy* / Q000401:mortality*; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: T-cell therapy; antiviral treatment; cytomegalovirus; hematopoeitic cell transplantation; immunoglobulin; pneumonia