Cytomegalovirus pneumonia in adult autologous blood and marrow transplant recipients

被引:75
作者
Konoplev, S
Champlin, RE
Giralt, S
Ueno, NT
Khouri, I
Raad, I
Rolston, K
Jacobson, K
Tarrand, J
Luna, M
Nguyen, Q
Whimbey, E
机构
[1] Univ Texas, MD Anderson Canc Ctr, Div Internal Med, Houston, TX 77030 USA
[2] Univ Texas, MD Anderson Canc Ctr, Dept Blood & Marrow Transplantat, Houston, TX 77030 USA
[3] Univ Texas, MD Anderson Canc Ctr, Dept Lab Med, Houston, TX 77030 USA
[4] Univ Texas, MD Anderson Canc Ctr, Dept Pathol, Houston, TX 77030 USA
关键词
autologous bone marrow transplantation; cytomegalovirus; pneumonia;
D O I
10.1038/sj.bmt.1702877
中图分类号
Q6 [生物物理学];
学科分类号
071011 ;
摘要
CMV pneumonia is a major cause of morbidity and mortality among allogeneic BMT recipients. To assess the frequency, timing, risk factors and response to therapy of CMV pneumonia among autologous BMT recipients, we reviewed our experience with 795 patients. Sixteen (2%) patients were diagnosed with CMV pneumonia, The frequency was higher among patients who were seropositive than those who were seronegative (3.3% vs 0%, P = 0.008). Among seropositive patients, the frequency was higher among patients with hematological malignancies than patients with solid tumors (5.0 % vs 1.0%, P = 0.019). Eleven cases occurred <30 days, and five cases occurred >100 days post transplant. The overall CMV pneumonia-related mortality rate was 31%. Seven (78%) of nine patients treated with ganciclovir and IVIG prior to respiratory failure survived; neither of two patients treated after respiratory failure survived. Four of five (80%) untreated patients survived. In conclusion, CMV is a not infrequent cause of pneumonia among autologous BMT recipients. Risk factors include CMV seropositivity and an underlying hematological malignancy. A favorable response hinges on the prompt initiation of therapy. The survival of 25% of the patients without antiviral therapy suggests that the isolation of CMV from a BAL specimen occasionally reflects oropharyngeal contamination or that CMV pneumonia may sometimes be self-limited in more immunocompetent autologous BMT recipients.
引用
收藏
页码:877 / 881
页数:5
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