Summary
CMV infection is the major infectious complication following bone marrow transplantation. It is most often related to reactivation of latent infection in patients who were CMV seropositive before BMT. The incidence and severity have recently been modified by the use of preventive and curative treatments. Prevention of CMV infection with the transfusion of seronegative blood products is useful only when donor and recipient are seronegative. High-dose acyclovir has been shown effective in one randomized study. A multicenter study is currently being performed in Europe to confirm this result. Intravenous gammaglobulins seemed to lower the number of patients who incur interstitial pneumonitis but not the incidence of viremia. They also decreased the incidence of gram-negative sepsis and severe GVH and improved survival. The treatment is based on the use of gancyclovir. Several studies show that gancyclovir is more effective in asymptomatic patients with viral isolation from blood or bronchoalveolar lavage. The addition to gancyclovir of high-dose gammaglobulin improves survival in symptomatic patients with interstitial pneumonitis. This progress in the prevention and treatment of CMV infection has improved the overall results of allogeneic bone marrow transplantation.
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References
Bowden RA, Sayers M, Flournoy N, et al. (1986) Cytomegalovirus immune globulin and seronegative blood products to prevent primary cytomegalovirus infection after marrow transplantation. N Engl J Med 314: 1006–1010
Bowden RA, Meyers JD (1990) Prophylaxis of cytomegalovirus infection. Semin Hematol 27: 17–21
Emanuel D, Cunningham I, Jules-Elysee K, et al. (1988) Cytomegalovirus pneumonia after bone marrow transplantation successfully treated with the combination of gancyclovir and highdose intravenous immune globulin. Ann Intern Med 109: 777–782
Emanuel D (1990) Treatment of cytomegalovirus disease. Semin Hematol 27: 22–27
Gluckman E, Devergie A, Melo R, et al. (1983) Prophylaxis of herpes infection after bone marrow transplantation by oral acyclovir. Lancet 2: 706–708
Meyers JD, Flournoy N, Thomas ED (1986) Risk factors for cytomegalovirus infection after human marrow transplantation. J Infect Dis 153: 478–488
Meyers JD, Reed EC, Shepp DH, et al. (1988) Acyclovir for prevention of cytomegalovirus infection and disease after allogeneic bone marrow transplantation. N Engl J Med 318: 70–75
Reed EC, Bowden RA, Dandliker PS, Lilleby KE, Meyers JD (1988) Treatment of cytomegalovirus pneumonia with gancyclovir and intravenous cytomegalovirus immunoglobulin in patients with bone marrow transplants. Ann Intern Med 109: 783–788
Schmidt GM, Horak DA, Niland JC, et al. (1991) A randomized, controlled trial of prophylactic gancyclovir for cytomegalovirus pulmonary infection in recipients of allogeneic bone marrow transplants. N Engl J Med 324: 1005–1011
Sullivan KM, Kopecky KJ, Jocom J, et al. (1990) Immunomodulatory and antimicrobial afficacy of intravenous immunoglobulin in bone marrow transplantation. N Engl J Med 323: 705–712
Winston DJ, Ho WG, Lin CH, et al. (1987) Intravenous immune globulin for prevention of cytomegalovirus infection and interstitial pneumonia after bone marrow transplantation. Ann Intern Med 106: 12–18
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Gluckman, E., Traineau, R., Devergie, A. et al. Prevention and treatment of CMV infection after allogeneic bone marrow transplant. Ann Hematol 64 (Suppl 1), A158–A161 (1992). https://doi.org/10.1007/BF01715372
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DOI: https://doi.org/10.1007/BF01715372