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Cytomegalovirus pneumonia after bone marrow transplantation. Risk factors and response to therapy
H Enright1, R Haake, D Weisdorf
1Department of Medicine, University of Minnesota, Minneapolis 55455.
Abstract:
Cytomegalovirus pneumonia complicated bone marrow transplantation in 75 (63 allogeneic and 12 autologous) of 1136 recipients (Kaplan-Meier incidence 8.8%). CMV pneumonia occurred more frequently in allogeneic (12.4%) than autologous recipients (3.3%). Increased risk for CMV pneumonia was observed in allogeneic recipients who were seropositive (relative risk = 2.9), older age (RR = 1.4 per decade), those conditioned with total-body irradiation (RR = 2.7), who received antithymocyte globulin (RR = 2.9) or T cell-depleted marrow (RR = 2.7) or who had CMV viruria (RR = 4.0) or viremia (RR = 5.9). Autologous recipients were also at increased risk if they were seropositive (RR = 6.1), or developed viruria (RR = 7.0) or viremia (RR = 15.4). Thirteen of 14 untreated patients died without improvement. Prognosis was poor in patients who were ventilator-dependent at initiation of therapy (median survival 17 days), with only 1 long-term survivor. In contrast, patients ventilator-independent at initiation of therapy with ganciclovir and immunoglobulin (n = 22) had a median survival of > 274 days, with 9 long-term survivors. Ganciclovir alone or acyclovir with immunoglobulin in ventilator-independent patients was less effective (median survivals 80 and 10 days, respectively). Overall, 10 of 75 patients were surviving 10-73 months (median 47) from diagnosis; 9 of these were ventilator-independent at initiation of therapy and received ganciclovir with immunoglobulin. CMV pneumonia was less common, but was severe in autologous recipients, with only 2 of 12 surviving. CMV pneumonia remains a prominent cause of death following BMT. Early therapy with ganciclovir and immunoglobulin before respiratory failure supervenes may improve survival.
Insights
Cytomegalovirus (CMV) pneumonia is a severe complication following bone marrow transplantation (BMT). Early treatment with ganciclovir and immunoglobulin before respiratory failure significantly improves survival rates in these patients.
Area of Science:
- Hematology
- Infectious Diseases
- Transplantation Immunology
Background:
- Cytomegalovirus (CMV) pneumonia is a significant complication after bone marrow transplantation (BMT).
- The incidence and risk factors for CMV pneumonia vary between allogeneic and autologous BMT recipients.
- CMV pneumonia carries a high mortality rate, particularly without timely and effective treatment.
Purpose of the Study:
- To investigate the incidence, risk factors, and outcomes of Cytomegalovirus (CMV) pneumonia following bone marrow transplantation (BMT).
- To evaluate the efficacy of different therapeutic strategies for CMV pneumonia in BMT recipients.
- To identify predictors of survival in patients with CMV pneumonia post-BMT.
Main Methods:
- Retrospective analysis of 1136 bone marrow transplant recipients.
- Kaplan-Meier analysis to determine incidence of CMV pneumonia.
- Risk factor analysis using relative risks (RR) and evaluation of treatment outcomes.
Main Results:
- CMV pneumonia occurred in 8.8% of BMT recipients (12.4% allogeneic, 3.3% autologous).
- Risk factors included CMV seropositivity, older age, TBI conditioning, ATG, T-cell depleted marrow, and CMV viruria/viremia.
- Treatment with ganciclovir and immunoglobulin in ventilator-independent patients showed significantly better survival (>274 days) compared to untreated or other treatment groups.
Conclusions:
- CMV pneumonia remains a major cause of mortality after BMT.
- Early intervention with ganciclovir and immunoglobulin, particularly before respiratory failure, is crucial for improving survival.
- Prognosis is poor for ventilator-dependent patients, highlighting the importance of preemptive therapy and risk factor management.