CMV pneumonia in allogeneic BMT recipients undergoing early treatment or pre-emptive ganciclovir therapy

Abstract

Summary: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 у2 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. Bone Marrow Transplantation (2000) 26, 413-417. Keywords: CMV; pneumonia; BMT; antigenemia; extended surveillance; IVIgIn the early eighties, cytomegalovirus interstitial pneumonia (CMV-IP) was considered a major infectious problem after allogeneic bone marrow transplantation (BMT) because mortality rates higher than 80% were observed even after the introduction of ganciclovir (GCV), the first antiviral with good in vitro and in vivo activity against cytomegalovirus. 1 More recently, the development of new techniques such as the CMV antigenemia (AG) assay and PCR have significantly contributed to the earlier diagnosis of active

Infections among allogeneic bone marrow transplant recipients in India

“…10,11 Early diagnosis of CMV antigenemia using PCR and preemptive therapy with ganciclovir, especially in patients 'at risk', may help in reducing the risk of CMV disease. 12,13 The incidence of hepatitis B and hepatitis C seems to be similar to western data. 14,15 Reactivation and hepatic dysfunction due to hepatitis B or C was uncommon among transplant recipients.…”

Extended antigenemia surveillance and late cytomegalovirus infection after allogeneic BMT

“…All these observations confirm previous reported data about the value of the AG test to monitor the duration of therapy and mainly to prevent unnecessary use of GCV. 16,22,24 We also observed that 32.4% of the AG episodes (both first and recurrent episodes) did not require GCV treatment (AG Ͻ2 cells) and undesirable antiviral side-effects could be avoided. It is important to stress that we prepared the AG slides with 300 000 polymorphonuclear leukocytes while other groups usually prepare slides with 50 000 to 200 000 PMN.…”

“…A Cox proportional hazards model considering the same covariates as above was fitted to the data. 16 …”

“…Comparing the events of CMV-IP in patients receiving early treatment (only if CMV disease was diagnosed) or intermittent pre-emptive GCV therapy (notably more courses of GCV), we observed that the median time for the occurrence of CMV pneumonia moved from 55 to 92 days. 16 In centers adopting GCV prophylaxis, some authors have described the occurrence of CMV-IP as late as 237 days after BMT (mean day of onset). 6 Another topic subject to discussion and not well-defined yet is related to the duration of GCV therapy.…”

CMV infections after hematopoietic stem cell transplantation

“…ganciclovir combined with high-dose Ig, but this standard has never been evaluated in a controlled study and more recent studies have questioned whether the addition of Ig improves outcome. 22 For patients with CMV disease other than pneumonia, the addition of Ig does not seem to be beneficial.…”