Abstract
Infections continue to be common complications of bone marrow transplantation [1–3]. Among the viral infections, cytomegalovirus infections cause the greatest morbidity and mortality [3,4]. A number of different clinical syndromes are associated with CMV infection, but the syndrome of greatest significance is CMV interstitial pneumonia. This review will focus on recent progress in understanding the epidemiology of CMV infection and interstitial pneumonia after marrow transplantation and on new approaches for the diagnosis, treatment, and prevention of CMV infection and pneumonia.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Similar content being viewed by others
References
Winston DJ, Ho WG, Champlin RE, Gale RP. Infectious complications of bone marrow transplantation. Exp Hematol 1984; 12:205–215.
Meyers JD, Atkinson K. Infection in bone marrow transplantation. Clin Hematol 1983; 12:791–811.
Burns WH, Wingard JR. Viral infection following bone marrow transplantation. In: Experimental Hematology Today—1987. Recent Advances and Future Directions in Bone Marrow Transplantation, Baum SJ, Santos GW, Takaku F, eds. Springer-Verlag, New York, 1988:165–170.
Winston DJ, Ho WG, Champlin RE. Cytomegalovirus infections after allogeneic bone marrow transplantation. Rev Infect Dis 1990, in press.
Neiman PE, Reeves W, Ray G, Flournoy N, Lerner KG, Sale GE, Thomas ED. A prospective analysis of interstitial pneumonia and opportunistic viral infection among recipients of allogeneic bone marrow grafts. J Infect Dis 1977; 136:754–767.
Winston DJ, Gale RP, Meyers DV, Young LS. UCLA Bone Marrow Transplant Group. Infectious complications of human bone marrow transplantation. Medicine (Baltimore) 1979; 58:1–31.
Meyers JD, Flournoy N, Thomas ED. Cytomegalovirus infection and specific cell-mediated immunity after marrow transplant. J Infect Dis 1980; 142:816–824.
Meyers JD, Flournoy N, Thomas ED. Risk factors for cytomegalovirus infection after human marrow transplant. J Infect Dis 1986; 153:478–488.
Paulin T, Ringden O, Lonngrist B, Wahren B, Nilsson B. The importance of pre bone marrow transplantation serology in determining subsequent cytomegalovirus infection. Scand J Infect Dis 1986; 18:199–209.
Miller W, Flynn P, McCullough J, Balfour HH, Goldman A, Haake R, McGlave P, Ramsay N, Kersey J. Cytomegalovirus infection after bone marrow transplantation: An association with acute graft-versus-host disease. Blood 1986; 67:1162–1167.
Wingard JR, Mellitis ED, Sostrin MB, Chen DVH, Burns WH, Santos GH, Vriesndorp HM, Beschorner WE, Sarai R. Interstitial pneumonitis after allogeneic bone marrow transplantation. Medicine (Baltimore) 1988; 67:175–186.
Wingard JR, Chen DVH, Burns WH, Fuller DJ, Braine HG, Yeager AM, Kaiser H, Burke PJ, Graham ML, Santos GW, Sarai R. Cytomegalovirus infection after autologous bone marrow transplantation with comparison to infection after allogeneic bone marrow transplantation. Blood 1988; 71:1432–1437.
Reusser P, Schoch HG, Fisher L, Thomas ED, Buckman CD, Meyers JD. Cytomegalovirus infection after autologous bone marrow transplantation: Occurrence of disease and impact on engraftment. Blood 1988; 72(Suppl l):402a.
Winston DJ, Huang ES, Miller MJ, Lin CH, Ho WE, Gale RG, Champlin RE. Molecular epidemiology of cytomegalovirus infections associated with bone marrow transplantation. Ann Intern Med 1985; 102:16–20.
Jordan MC, Shanley JD, Stevens JG. Immunosuppression reactivates and disseminates latent murine cytomegalovirus. J Gen Virol 1977; 37:419–423.
Mayo DR, Armstrong JA, Ho M. Reactivation of murine cytomegalovirus by cyclophosphamide. Nature 1977; 267:721–723.
Dowling JN, Wu BC, Armstrong JA, Ho M. Enhancement of murine cytomegalovirus infection during graft-versus-host reaction. J Infect Dis 1977; 135:990–994.
Winston DJ, Ho WG, Howell CL, Miller MJ, Mickey R, Martin WJ, Lin CH, Gale RP. Cytomegalovirus infections associated with leukocyte transfusions. Ann Intern Med 1980; 93:671–678.
Hersman J, Meyers JD, Thomas ED, Buckner CD, Clift R. The effect of granulocyte transfusion upon the incidence of cytomegalovirus infection after allogeneic marrow transplantation. Ann Intern Med 1982; 96:149–152.
Bowden RA, Sayers M, Gleaves CA, Banaji B, Newton B, Meyers JD. Cytomegalovirus-seronegative blood components for the prevention of primary cytomegalovirus infection after marrow transplantation. Considerations for blood banks. Transfusion 1987; 27:478–481.
Bowden RA, Sayers M, Flournoy N, Newton B, Banaji M, Thomas ED, Meyers JD. Cytomegalovirus immune globulin and seronegative blood products to prevent primary cytomegalovirus infection after marrow transplantation. N Engl J Med 1986; 314:1006–1010.
Apperley JF, Goldman JM. Cytomegalovirus: Biology, clinical features, and methods for diagnosis. Bone Marrow Transplant 1988; 2:253–264.
McDonald GB, Sharma P, Hackman RC, Meyers JD, Thomas ED. Esophageal infections in immunosuppressed patients after marrow transplantation. Gastroenterology 1985; 88: 1111–1117.
Spencer GD, Hackman RC, McDonald GB, Amos DE, Cunningham BA, Meyers JD, Thomas ED. A prospective study of unexplained nausea and vomiting after marrow transplantation. Transplantation 1986; 42:602–607.
Meyers JD, Flournoy N, Thomas ED. Nonbacterial pneumonia after allogeneic marrow transplantation. A review of ten years’ experience. Rev Infect Dis 1982; 4:1119–1132.
Weiner RS, Bortin MM, Gale RP, Gluckman E, Kay HEM, Kolb HJ, Hartz AJ. Interstitial pneumonitis after bone marrow transplantation. Assessment of risk factors. Ann Intern Med 1986; 104:168–175.
Weiner RS. Interstitial pneumonia following bone marrow transplantation. In: Progress in Bone Marrow Transplantation, Gale RP, Champlin RE, eds. Alan R Liss, New York, 1987:507–523.
Appelbaum FR, Meyers JD, Fefer A, Flournoy N, Cheever MA, Greenberg PD, Hackman R, Thomas ED. Nonbacterial nonfungal pneumonia following marrow transplantation in 100 identical twins. Transplantation 1982; 33:265–268.
Pecego R, Hill R, Appelbaum FR, Amos D, Buckner CD, Fefer A, Thomas ED. Interstitial pneumonitis following autologous bone marrow transplantation. Transplantation 1986; 42:515–517.
Wingard JR, Sostrin MB, Viriesendorp HM, Mellits ED, Santos GW, Fuller DJ, Braine HG, Yeager AM, Burns WH, Sarai R. Interstitial pneumonitis following autologous bone marrow transplantation. Transplantation 1988; 46:61–65.
Valteau P, Hartmann O, Benhamon E, Callaud JM, Brugieres L, Beaujeau F, Patte C, Flamant F, Lemerle J. Nonbacterial nonfungal interstitial pneumonitis following autologous bone marrow transplantation in children treated with high-dose chemotherapy without total-body irradiation. Transplantation 1988; 45:737–740.
Meyers JD, Flournoy N, Wade JC, Hackman RC, McDougall JK, Neiman PE, Thomas ED. Biology of interstitial pneumonia after marrow transplantation. In: Recent Advances in Bone Marrow Transplantation, Gale RP, ed. Alan R Liss, New York, 1983:405–423.
Meyers JD, Flournoy N, Thomas ED. Cytomegalovirus infection and specific cell-mediated immunity after marrow transplant. J Infect Dis 1980; 142:816–824.
Quinnan G, Kirmani N, Rook AH, Manischewitz JF, Jackson L, Moreschi G. Santos GW, Sarai R, Burns WH. Cytotoxic T-cells in cytomegalovirus infection: HLA-restricted T-lymphocyte and non-T-lymphocyte cytotoxic responses correlate with recovery from cytomegalovirus infection in bone marrow transplant recipients. N Engl J Med 1982; 307:7–13.
Bowden RA, Day LM, Amos DE, Meyers JD. Natural cytotoxic activity against cyto-megalovirus-infected target cells following marrow transplantation. Transplantation 1987; 44:504–507.
Winston DJ, Territo MC, Ho WG, Miller MJ, Gale RP, Golde DW. Alveolar macrophage dysfunction in human bone marrow transplant recipients. Am J Med 1982; 73:859–866.
Wingard JR, Santos GW, Sarai R. Late-onset interstitial pneumonia following allogeneic bone marrow transplant. Transplantation 1985; 39:21–23.
Beschorner WE, Hutchins GM, Burns WH, Sarai R, Tutschka P, Santos GW. Cytomegalovirus pneumonia in bone marrow transplant recipients: Miliary and diffuse patterns. Am Rev Respir Dis 1980; 122:107–114.
Bryson YJ, Jordan MC, Winston DJ, Coloma L, Gale RP. Prospective study of viral infections and interstitial pneumonia in bone marrow transplant recipients. Clin Res 1980; 28: 111a.
Zia JA, Forman SJ, Gallagher MT, Vanderwal-Urbina E, Blume KG. Prolonged human cytomegalovirus viremia following bone marrow transplantation. Transplantation 1984; 37:315–317.
Schmidt GM, Zaia J, Horak D, Kovacs A, Hawkins G, Nademanee A, O’Donnell MR, Snyder DS, Stein AS, Parker PM, Hill R, Blume KG, Forman SJ. Human cytomegalovirus detection in routine bronchoalveolar lavage specimen as a predictor for interstitial pneumonia in allogeneic bone marrow transplant recipients (abstract 1531). Blood 1988; 72 (Suppl 1):405a.
Springmeyer SC, Silvestri RC, Sale GE, Peterson DL, Weems CE, Huseby JS, Hudson LD, Thomas ED. The role of transbronchial biopsy for the diagnosis of diffuse pneumonias in immunocompromised marrow transplant recipients. Am Rev Respir Dis 1982; 126:763–765.
Miller MJ. Rapid diagnosis of pulmonary cytomegaloviral infection (abstract C-294). In: Abstracts of the Annual Meeting of the American Society for Microbiology. American Society for Microbiology, Washington, DC, 1986.
Emanuel D, Peppard J, Stover D, Gold J, Armstrong D, Hammerling V. Rapid immuno-diagnosis of cytomegalovirus pneumonia by bronchoalveolar lavage using human and murine monoclonal antibodies. Ann Intern Med 1986; 104:476–481.
Cordonnier C, Escudier E, Nicolas JC, Fleury J, Deforges L, Ingrand D, Bircout F, Bernandin JF. Evaluation of three assays on alveolar lavage fluid in the diagnosis of cytomegalovirus pneumonitis after bone marrow transplantation. J Infect Dis 1987; 155:495–500.
Crawford SW, Bowden RA, Hackman RC, Gleaves CA, Meyers JD, Clark JG. Rapid detection of cytomegalovirus pulmonary infection by bronchoalveolar lavage and centrifuga-tion culture. Ann Intern Med 1988; 108:180–185.
Gleaves CA, Myerson D, Bowden RA, Hackman RC, Meyers JD. Direct detection of cytomegalovirus from bronchoalveolar lavage using a rapid in-situ DNA hybridization assay compared to centrifugation culture (abstract 808). In: Program and Abstracts of the 28th Interscience Conference on Antimicrobial Agents and Chemotherapy. American Society for Microbiology, Washington, DC, 1988.
Winston DJ, Ho WG, Gale RP, Champlin RE. Treatment and prevention of interstitial pneumonia after bone marrow transplantation. In: Progress in Bone Marrow Transplantation, Gale RP, Champlin RE, eds. Alan R Liss, New York, 1987:525–544.
Winston DJ, Ho WG, Gale RP, Champlin RE. Prevention and treatment of infections after bone marrow transplantation. In: Experimental Hematology Today—1987. Recent Advances and Future Directions in Bond Marrow Transplantation. Bawn SJ, Santos GW, Takaku F, eds. Springer-Verlag, New York, 1987:177–186.
Cheng YC, Huang ES, Lin JC, Mar EC, Pagano JS, Dutschman GE, Grill SP. Unique spectrum of activity of 9[(l,3-dihydroxy-2-propoxy)methyl] guanine against herpes viruses in vitro and its mode of action against herpes simplex virus type 1. Proc Natl Acad Sci USA 1983; 80:2767–2770.
Shepp DH, Dandliker PS, DeMiranda P, Burnette TC, Cederberg DM, Kirk LE, Meyers JD. Activity of 9-[2-hydroxy-l-(hydroxymethyl)ethoxymethyl] guanine in the treatment of cytomegalovirus pneumonia. Ann Intern Med 1985; 103:368–373.
Winston DJ, Ho WG, Bartoni K, Holland GN, Mitsuyasu RT, Gale RP, Busuttil RW, Champlin RE. Ganciclovir therapy for cytomegalovirus infections in recipients of bone marrow transplants and other immunosuppressed patients. Rev Infect Dis 1988; 10(Suppl 3):S547-S553.
Erice A, Jordan MC, Chace BA, Fletcher C, Chinnock BJ, Balfour HH, Jr. Ganciclovir treatment of cytomegalovirus disease in transplant recipients and other immunocompromised hosts. JAMA 1987; 257:3082–3087.
Winston DJ, Ho WG, Champlin RE. Use of DHPG (ganciclovir) and intravenous immune globulin in bone marrow transplants. In: Bone Marrow Transplantation: Current Controversies. Gale RP, Champlin RE, eds. Alan R Liss, New York, 1989:553–651.
Reed EC, Dandliker PS, Meyers JD. Treatment of cytomegalovirus pneumonia with 9-[2-hydroxy-l(hydroxmethyl) ethoxmethyl] guanine and high-dose corticosteriods. Ann Intern Med 1986; 105:214–215.
Bratanow NC, Ash RC, Turner PA, Smith R, Haasler G, Chitambar C, Hansen R, Casper J. Successful treatment of serious cytomegalovirus disease with 9(1, 3-dihydroxy-2-propoxymethyl) guanine (ganciclovir, DHPG) and intravenous immunoglobulin in bone marrow transplant patients (abstract no. 254). Exp Hematol 1987; 15:541.
Emanuel D, Cunningham I, Jules-Elysee K, Brochstein JA, Kerman NA, Laver J, Stover D, White DA, Fels A, Polsky B, Castro-Malaspina H, Peppard JR, Bartus P, Hammerling U, O’Reilly RJ. Cytomegalovirus pneumonia after bone marrow transplantation successfully treated with the combination of ganciclovir and high-dose intravenous immune globulin. Ann Intern Med 1988; 109:777–782.
Reed EC, Bowden RA, Dandliker PS, Lilleby KE, Meyers JD. Treatment of cytomegalovirus pneumonia with ganciclovir and intravenous cytomegalovirus immunoglobulin in patients with bone marrow transplants. Ann Intern Med 1988; 109:783–788.
Schmidt GM, Kovacs A, Zaia JA, et al. Ganciclovir/immunoglobulin combination therapy for the treatment of human cytomegalovirus-associated interstitial pneumonia in bone marrow allograft recipients. Transplantation 1988; 46:905–907.
Grundy JE, Shanley, JD, Griffith PD. Is cytomegalovirus interstitial pneumonitis in transplant recipients an immunopathological condition? Lancet 1987; 2:996–999.
Wilson EJ, Medearis DN Jr, Hansen LA, Rubin RH. 9-(1,3-dihydroxy-2-propoxymethyl) quanine prevents death but not immunity in murine cytomegalovirus-infected normal and immunosuppressed BALB/c mice. Antimicrob Agents Chemother 1987; 31:1017–1020.
Reed EC, Shepp DH, Dandliker PS, Meyers JD. Ganciclovir treatment of cytomegalovirus infection of the gastrointestinal tract after marrow transplantation. Bone Marrow Transplant 1987; 2:299–305.
Winston DJ, Pollard RB, Ho WG, Gallagher JG, Rasmussen LE, Huang SN, Lin CH, Gosset TG, Merigan TC, Gale RP. Cytomegalovirus immune plasma in bone marrow transplant recipients. Ann Intern Med 1982; 97:11–18.
Meyers JD, Leszcynski J, Zaia JA, Flournoy N, Newton B, Syndman DR, Wright GG, Levin MJ, Thomas ED. Prevention of cytomegalovirus infection by cytomegalovirus immune globulin after marrow transplantation. Ann Intern Med 1983; 98:442–446.
O’Reilly RJ, Reich L, Gold J, Kirkpatrick D, Dinsmore R, Kapoon N, Condie R. A randomized trial of intravenous hyperimmune globulin for the prevention of cytomegalovirus (CMV) infections following marrow transplantation: Preliminary results. Transplant Proc 1983; 15:1405–1411.
Kubanek B, Ernst P, Ostendorf P, Schafter U, Wolf H. Preliminary data of a controlled trial of intravenous hyperimmune globulin in the prevention of cytomegalovirus infection in bone marrow transplant recipients. Transplant Proc 1985; 17:468–469.
Winston DJ, Ho WG, Lin CH, Bartoni K, Budinger MD, Gale RP, Champlin RE. Intravenous immunoglubulin for prevention of cytomegalovirus infection and interstitial pneumonia after bone marrow transplantation. Ann Intern Med 1987; 106:12–18.
Miller W, McCullough J, Balfour HH, Haake R, Ramsay NKC, Goldman A, Bowman R, Kersey J. Prevention of CMV infection by blood products: A randomized trial (abstract No. K128). J Cell Biochem 1988:12(Suppl c):93.
Peterson FB, Bowden RA, Thornquist M, et al. The effect of prophylactic intravenous immune globulin on the incidence of septicemia in marrow transplant recipients. Bone Marrow Transplant 1987; 2:141–148.
Graham-Pole J, Camitta B, Casper J, et al. Intravenous immunoglobulin may lessen all forms of infection in patients receiving allogeneic bone marrow transplantation for acute lymphoblastic leukemia: A Pediatric Oncology Group study. Bone Marrow Transplant 1988; 3:559–566.
Sullivan KM, Kopecky K, Jocom J, et al. Antimicrobial and immunomodulatory effects of intravenous immunoglobulin in bone marrow transplantation. In: Program and Abstracts of the Twenty-Eighth Interscience Conference on Antimicrobial Agents and Chemotherapy. American Society for Microbiology, Washington DC, 1988:216.
Ringden O, Pihlstedt P, Volin L. Nikoskelainen J, Lonnqvist B, Ruutu P, Ruutu T, Toi-vanen A, Wahren B. Failure to prevent cytomegalovirus infection by cytmegalovirus hyperimmune plasma: A randomized trial by the Nordic Bone Marrow Transplantation Group. Bone Marrow Transplant 1987; 2–299–305.
Meyers JD, Reed EC, Shepp DH, Thornquist M, Dandliker PS, Vicary CA, Flournoy N, Kirk LE, Kersey JH, Thomas ED, Balfour HH. Acyclovir for prevention of cytomegalovirus infection and disease after allogeneic marrow transplantation. N Engl J Med 1988; 318:70–75.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1990 Kluwer Academic Publishers
About this chapter
Cite this chapter
Winston, D.J., Ho, W.G., Champlin, R.E. (1990). Cytomegalovirus infection and interstitial pneumonia after bone marrow transplantation. In: Champlin, R. (eds) Bone Marrow Transplantation. Cancer Treatment and Research, vol 50. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-1493-6_7
Download citation
DOI: https://doi.org/10.1007/978-1-4613-1493-6_7
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4612-8803-9
Online ISBN: 978-1-4613-1493-6
eBook Packages: Springer Book Archive