Prophylactic adenine arabinoside following marrow transplantation

Interstitial pneumonia is a major cause of morbidity and mortality following allogeneic marrow transplantation for hematologic malignancy. In this prospective randomized study, 22 of 40 patients received prophylactic adenine arabinoside (Ara-A) at a dose of 5 mg/kg/day administered intravenously on an intermittent schedule. Thirteen episodes of interstitial pneumonia occurred among treated patients, including three cases associated with cytomegalovirus (CMV) in the lung. Ten episodes of interstitial pneumonia were seen in the untreated group, with CMV cultured from five. Surveillance viral cultures were positive from 18 different sites in 12 treated patients compared to 10 sites from 7 patients in the untreated group. No significant toxicity from Ara-A was encountered, and no difference in overall survival between the two groups was detected. Ara-A did not reduce the frequency of interstitial pneumonia or viral isolation from routine cultures.