Late Infection With Cytomegalovirus a Serious Problem in Bone Marrow Transplant Patients

NEW ORLEANS--Ganciclovir (Cytovene) protects allogeneic bone marrow transplant (BMT) recipients in the early postoperative period, but late infection with cytomegalovirus (CMV) continues to cause serious problems, Helen C. Maltezou, MD, reported at the 36th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC).

Dr. Maltezou and her colleagues at the University of Texas M.D. Anderson Cancer Center reviewed the incidence and mortality associated with CMV disease occurring from 100 to 365 days post-transplant in 156 adults with leukemia and lymphoma who received ganciclovir prophylaxis during the first 100 days post-transplant.

Most of the patients were given ganciclovir 5 mg/kg intravenously either three or five times a week. Either the donor or the patient was seropositive for CMV.

Late CMV disease developed in 16 patients (13%) at a median of 200 days post-transplant; 14 had pneumonia, one had gastrointestinal disease, and one had both. A serious concurrent infection was present in 11 of the 16 patients, said Dr. Maltezou, of the Section of Infectious Diseases.

Of seven patients getting peripheral blood stem cell (PBSC) transplant, four (57%) developed CMV disease, a much higher percentage than the 8% receiving bone marrow transplant.

Outcome was grim, as 12 patients (71%) died. Concurrent infection did not increase the odds of dying, Dr. Maltezou said.

Statistically significant risk factors for the development of late CMV disease were age more than 40 years, the use of an unrelated donor, the use of antithymocyte globulin, CMV shedding during the first 100 days post-transplant, and the development of acute or chronic graft-versus-host disease.

5 Times a Week Better Than 3

A related study from the M.D. Anderson Cancer Center compared the efficacy of 5 mg/kg of ganciclovir in two different schedules administered from engraftment to 100 days post-transplant.

The results showed that five times per week was more effective than three times per week. The study included 215 adult allogeneic bone marrow and PBSC transplant recipients.

Active CMV infection occurred in 41% of patients receiving the drug three times per week but in only 21% of patients getting the drug five times per week, Dr. Maltezou reported.

CMV disease occurred in 16% versus 4%, and CMV-related mortality was 12% versus 1.5%, respectively, for three doses compared with five. Overall mortality was no different.

Besides three-times-per-week dosing, other risk factors for CMV disease in the first 100 days post-transplant, in this cohort, were T-cell-depleted marrow and the use of FK 506 in graft-versus-host disease prophylaxis, Dr. Maltezou commented.