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. 1993 May;46(5):415–419. doi: 10.1136/jcp.46.5.415

Cytomegalovirus pneumonitis and bone marrow transplantation: identification of a specific high risk group.

A B Foot 1, E O Caul 1, A P Roome 1, J M Darville 1, A Oakhill 1
PMCID: PMC501249  PMID: 8391547

Abstract

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.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Apperley J. F., Jones L., Hale G., Waldmann H., Hows J., Rombos Y., Tsatalas C., Marcus R. E., Goolden A. W., Gordon-Smith E. C. Bone marrow transplantation for patients with chronic myeloid leukaemia: T-cell depletion with Campath-1 reduces the incidence of graft-versus-host disease but may increase the risk of leukaemic relapse. Bone Marrow Transplant. 1986 May;1(1):53–66. [PubMed] [Google Scholar]
  2. Atkinson K., Downs K., Golenia M., Biggs J., Marshall G., Dodds A., Concannon A. Prophylactic use of ganciclovir in allogeneic bone marrow transplantation: absence of clinical cytomegalovirus infection. Br J Haematol. 1991 Sep;79(1):57–62. doi: 10.1111/j.1365-2141.1991.tb08007.x. [DOI] [PubMed] [Google Scholar]
  3. Bowden R. A., Fisher L. D., Rogers K., Cays M., Meyers J. D. Cytomegalovirus (CMV)-specific intravenous immunoglobulin for the prevention of primary CMV infection and disease after marrow transplant. J Infect Dis. 1991 Sep;164(3):483–487. doi: 10.1093/infdis/164.3.483. [DOI] [PubMed] [Google Scholar]
  4. Bowden R. A., Sayers M., Flournoy N., Newton B., Banaji M., Thomas E. D., Meyers J. D. Cytomegalovirus immune globulin and seronegative blood products to prevent primary cytomegalovirus infection after marrow transplantation. N Engl J Med. 1986 Apr 17;314(16):1006–1010. doi: 10.1056/NEJM198604173141602. [DOI] [PubMed] [Google Scholar]
  5. Condie R. M., O'Reilly R. J. Prevention of cytomegalovirus infection by prophylaxis with an intravenous, hyperimmune, native, unmodified cytomegalovirus globulin. Randomized trial in bone marrow transplant recipients. Am J Med. 1984 Mar 30;76(3A):134–141. doi: 10.1016/0002-9343(84)90332-2. [DOI] [PubMed] [Google Scholar]
  6. Einsele H., Vallbracht A., Friese M., Schmidt H., Haen M., Dopfer R., Niethammer D., Waller H. D., Ehninger G. Significant reduction of cytomegalovirus (CMV) disease by prophylaxis with CMV hyperimmune globulin plus oral acyclovir. Bone Marrow Transplant. 1988 Nov;3(6):607–617. [PubMed] [Google Scholar]
  7. Emanuel D., Cunningham I., Jules-Elysee K., Brochstein J. A., Kernan N. A., Laver J., Stover D., White D. A., Fels A., Polsky B. Cytomegalovirus pneumonia after bone marrow transplantation successfully treated with the combination of ganciclovir and high-dose intravenous immune globulin. Ann Intern Med. 1988 Nov 15;109(10):777–782. doi: 10.7326/0003-4819-109-10-777. [DOI] [PubMed] [Google Scholar]
  8. Grob J. P., Grundy J. E., Prentice H. G., Griffiths P. D., Hoffbrand A. V., Hughes M. D., Tate T., Wimperis J. Z., Brenner M. K. Immune donors can protect marrow-transplant recipients from severe cytomegalovirus infections. Lancet. 1987 Apr 4;1(8536):774–776. doi: 10.1016/s0140-6736(87)92800-5. [DOI] [PubMed] [Google Scholar]
  9. Grundy J. E., Shanley J. D., Griffiths P. D. Is cytomegalovirus interstitial pneumonitis in transplant recipients an immunopathological condition? Lancet. 1987 Oct 31;2(8566):996–999. doi: 10.1016/s0140-6736(87)92560-8. [DOI] [PubMed] [Google Scholar]
  10. Mackinnon S., Burnett A. K., Crawford R. J., Cameron S., Leask B. G., Sommerville R. G. Seronegative blood products prevent primary cytomegalovirus infection after bone marrow transplantation. J Clin Pathol. 1988 Sep;41(9):948–950. doi: 10.1136/jcp.41.9.948. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. May A. G., Betts R. F., Freeman R. B., Andrus C. H. An analysis of cytomegalovirus infection and HLA antigen matching on the outcome of renal transplantation. Ann Surg. 1978 Feb;187(2):110–117. doi: 10.1097/00000658-197802000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Meyers J. D., Flournoy N., Thomas E. D. Nonbacterial pneumonia after allogeneic marrow transplantation: a review of ten years' experience. Rev Infect Dis. 1982 Nov-Dec;4(6):1119–1132. doi: 10.1093/clinids/4.6.1119. [DOI] [PubMed] [Google Scholar]
  13. Meyers J. D., Flournoy N., Thomas E. D. Risk factors for cytomegalovirus infection after human marrow transplantation. J Infect Dis. 1986 Mar;153(3):478–488. doi: 10.1093/infdis/153.3.478. [DOI] [PubMed] [Google Scholar]
  14. Meyers J. D., Reed E. C., Shepp D. H., Thornquist M., Dandliker P. S., Vicary C. A., Flournoy N., Kirk L. E., Kersey J. H., Thomas E. D. Acyclovir for prevention of cytomegalovirus infection and disease after allogeneic marrow transplantation. N Engl J Med. 1988 Jan 14;318(2):70–75. doi: 10.1056/NEJM198801143180202. [DOI] [PubMed] [Google Scholar]
  15. Reed E. C., Bowden R. A., Dandliker P. S., Lilleby K. E., Meyers J. D. Treatment of cytomegalovirus pneumonia with ganciclovir and intravenous cytomegalovirus immunoglobulin in patients with bone marrow transplants. Ann Intern Med. 1988 Nov 15;109(10):783–788. doi: 10.7326/0003-4819-109-10-783. [DOI] [PubMed] [Google Scholar]
  16. Schmidt G. M., Horak D. A., Niland J. C., Duncan S. R., Forman S. J., Zaia J. A. A randomized, controlled trial of prophylactic ganciclovir for cytomegalovirus pulmonary infection in recipients of allogeneic bone marrow transplants; The City of Hope-Stanford-Syntex CMV Study Group. N Engl J Med. 1991 Apr 11;324(15):1005–1011. doi: 10.1056/NEJM199104113241501. [DOI] [PubMed] [Google Scholar]
  17. Verdonck L. F., de Gast G. C., Dekker A. W., de Weger R. A., Schuurman H. J., Rozenberg-Arska M. Treatment of cytomegalovirus pneumonia after bone marrow transplantation with cytomegalovirus immunoglobulin combined with ganciclovir. Bone Marrow Transplant. 1989 Mar;4(2):187–189. [PubMed] [Google Scholar]
  18. Winston D. J., Ho W. G., Lin C. H., Bartoni K., Budinger M. D., Gale R. P., Champlin R. E. Intravenous immune globulin for prevention of cytomegalovirus infection and interstitial pneumonia after bone marrow transplantation. Ann Intern Med. 1987 Jan;106(1):12–18. doi: 10.7326/0003-4819-106-1-12. [DOI] [PubMed] [Google Scholar]

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