Treatment of cytomegalovirus pneumonia

In a multicenter uncontrolled trial of ganciclovir therapy for well-documented cytomegalovirus (CMV) pneumonia in 21 patients following bone marrow transplantation, eight (38%) of 21 survived for more than 90 days. Two additional patients responded to ganciclovir therapy; one survived for 60 days before relapsing with fatal CMV pneumonia, and the other survived 79 days before dying with disseminated aspergillosis. No CMV disease was found in this latter patient at autopsy. The improved survival of patients in this trial may be due to a small number of patients (23%) who developed significant neutropenia during ganciclovir therapy, to the concurrent use of CMV immune globulin in three of the survivors, or to other variables affecting a positive outcome. Data on the use of CMV DNA-DNA hybridization assays to detect CMV DNA directly in patients' blood suggest that this method may be useful in following the clearance of CMV viremia in patients receiving ganciclovir. The results of treatment of CMV pneumonia in bone marrow transplant recipients are compared with those of previous studies, of CMV pneumonia in renal transplant recipients, and of CMV pneumonia in patients with AIDS. Suggestions for further, more definitive, studies of CMV pneumonia are presented.