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Cytomegalovirus pneumonitis and bone marrow transplantation: identification of a specific high risk group
A B Foot1, E O Caul, A P Roome
1Bone Marrow Transplant Unit, Royal Hospital for Sick Children, Bristol.
Aims:
To study the association between cytomegalovirus (CMV) excretion and interstitial pneumonitis in allogeneic bone marrow transplant (BMT) recipients, with reference to donor and recipient CMV antibody response.
Methods:
The incidence of CMV excretion was prospectively studied in 62 allogeneic bone marrow transplantations performed on adults and children. All recipients received CMV seronegative blood products. Prophylaxis with high dose acyclovir and CMV immune globulin was given to high risk patients (donor or recipient, or both, CMV seropositive).
Results:
CMV excretion was detected in eight of 26 (31%) high risk patients but in only one of 36 low risk patients (donor and recipient both CMV seronegative). Five of the eight (63%) excretors in the high risk category developed CMV, of whom four (80%) belonged to the seropositive recipient/seronegative donor group, and included the three CMV seropositive recipients whose CMV complement fixation antibody titres were 64 or greater before transplantation.
Conclusions:
These findings suggest that there is a subgroup of patients at especially high risk of developing CMV.
Insights
Cytomegalovirus (CMV) excretion is linked to interstitial pneumonitis in bone marrow transplant (BMT) patients. High-risk individuals, particularly those with CMV-seropositive recipients and seronegative donors, face an elevated risk of developing CMV post-transplant.
Area of Science:
- Immunology
- Hematology
- Transplantation Medicine
Background:
- Cytomegalovirus (CMV) infection poses a significant risk in allogeneic bone marrow transplant (BMT) recipients.
- Understanding the relationship between CMV excretion and post-transplant complications like interstitial pneumonitis is crucial for patient management.
Purpose of the Study:
- To investigate the association between cytomegalovirus (CMV) excretion and interstitial pneumonitis in allogeneic bone marrow transplant (BMT) recipients.
- To analyze the influence of donor and recipient CMV antibody status on this association.
Main Methods:
- A prospective study of 62 allogeneic BMT recipients (adults and children).
- All recipients received CMV-seronegative blood products.
- High-risk patients (CMV-seropositive donor or recipient) received prophylaxis with high-dose acyclovir and CMV immune globulin.
Main Results:
- CMV excretion occurred in 31% of high-risk patients versus 3% of low-risk patients.
- Of those excreting CMV, 63% developed CMV disease.
- Four of five CMV disease cases were in seropositive recipients with seronegative donors, including three recipients with pre-transplant CMV antibody titers ≥64.
Conclusions:
- A specific subgroup of allogeneic BMT patients is identified as being at particularly high risk for developing CMV.
- Recipient CMV seropositivity, especially with high pre-transplant antibody titers, combined with a seronegative donor, indicates a heightened risk profile.