Cytomegalovirus pneumonia in adult autologous blood and marrow transplant recipients

Abstract

Summary:CMV pneumonia is a major cause of morbidity and mortality among allogeneic BMT recipients. To assess the frequency, timing, risk factors and response to therapy of CMV pneumonia among autologous BMT recipients, we reviewed our experience with 795 patients. Sixteen (2%) patients were diagnosed with CMV pneumonia. The frequency was higher among patients who were seropositive than those who were seronegative (3.3% vs 0%, P = 0.008). Among seropositive patients, the frequency was higher among patients with hematological malignancies than patients with solid tumors (5.0 % vs 1.0%, P = 0.019). Eleven cases occurred Ͻ30 days, and five cases occurred Ͼ100 days post transplant. The overall CMV pneumonia-related mortality rate was 31%. Seven (78%) of nine patients treated with ganciclovir and IVIG prior to respiratory failure survived; neither of two patients treated after respiratory failure survived. Four of five (80%) untreated patients survived. In conclusion, CMV is a not infrequent cause of pneumonia among autologous BMT recipients. Risk factors include CMV seropositivity and an underlying hematological malignancy. A favorable response hinges on the prompt initiation of therapy. The survival of 25% of the patients without antiviral therapy suggests that the isolation of CMV from a BAL specimen occasionally reflects oropharyngeal contamination or that CMV pneumonia may sometimes be self-limited in more immunocompetent autologous BMT recipients. Bone Marrow Transplantation (2001) 27, 877-881.

Active CMV disease does not always correlate with viral load detection

“…More intensive regimens, including fludarabine and tandem transplants, have been associated with reactivation of CMV. 16,17 In the current series of patients who underwent preemptive monitoring, CMV disease was not observed in association with autoSCT. The absence of CMV disease in this series is due either to a less severe natural history of CMV disease in this setting or to surveillance assisting in early detection and treatment.…”

Cytomegalovirus in Hematopoietic Stem Cell Transplant Recipients

“…[53][54][55] CMV pneumonia often manifests with fever, nonproductive cough, hypoxia, and infiltrates commonly interstitial on radiography. The diagnosis of CMV pneumonia is established by detection of CMV by shell-vial, culture, or histology in BAL or lung biopsy specimens, in the presence of compatible clinical signs and symptoms.…”

Correlation between Viral Loads of Cytomegalovirus in Blood and Bronchoalveolar Lavage Specimens from Lung Transplant Recipients Determined by Histology and Immunohistochemistry

“…The CMV viral load determined with the end-organ sample, the BAL fluid sample, was higher than the corresponding viral load determined with blood. Both IHC and determination of the CMV viral load in BAL samples may be useful for the detection of individuals at risk for the development of fulminant invasive CMV disease.Cytomegalovirus (CMV) pneumonitis is associated with high rates of morbidity and mortality rate in solid-organ, blood, and bone marrow transplant recipients (5,7,10,19,20). CMV pneumonitis is quite common in lung transplant recipients in particular, as it develops in more than half of all lung transplant recipients over the first 3 years after transplantation (4, 14, 21).…”

“…Cytomegalovirus (CMV) pneumonitis is associated with high rates of morbidity and mortality rate in solid-organ, blood, and bone marrow transplant recipients (5,7,10,19,20). CMV pneumonitis is quite common in lung transplant recipients in particular, as it develops in more than half of all lung transplant recipients over the first 3 years after transplantation (4, 14, 21).…”