Treatment of cytomegalovirus disease
- PMID: 2160128
Treatment of cytomegalovirus disease
Abstract
Cytomegalovirus (CMV) infection, particularly CMV pneumonitis, continues to be an important infectious complication following allogeneic bone marrow transplantation. Most bone marrow transplant (BMT) centers have reported an overall incidence of CMV pneumonitis of 15% to 20%. Until recently, the mortality rate from CMV pneumonitis has been extremely high (greater than 80%). Historically, both single-agent therapy and combination treatments have failed to increase survival of BMT recipients with CMV pneumonia. The introduction of new antiviral agents with potent activity against CMV in vitro, such as ganciclovir and trisodium phosphonoformate, seemed to offer promise for improving survival. However, as single agents, a significant impact on mortality has not been achieved with either. The addition of high-dose intravenous immunoglobulin (IVIG) to ganciclovir appears to have a significant impact on mortality due to CMV pneumonia following bone marrow transplantation. The mechanism by which IVIG exerts its clinical effect remains to be determined, and a better understanding of the underlying process may improve this approach in the future. Bone marrow toxicity associated with ganciclovir remains a particular problem in the BMT population. Strategies to circumvent this problem, such as the use of hematopoietic stem cell growth factors or the use of an agent that is less bone marrow suppressive, such as phosphonoformate, may also increase the effectiveness of treating CMV pneumonia.
Similar articles
-
Successful treatment of cytomegalovirus pneumonitis with ganciclovir and high-dose intravenous immunoglobulin in a bone marrow transplant recipient.J Formos Med Assoc. 1992 Oct;91(10):996-1000. J Formos Med Assoc. 1992. PMID: 1362680
-
Treatment of severe cytomegalovirus infection with ganciclovir and high-dose intravenous immunoglobulin in patients with allogeneic bone marrow transplants. A pilot study.Nouv Rev Fr Hematol (1978). 1990;32(1):17-20. Nouv Rev Fr Hematol (1978). 1990. PMID: 2161510
-
Successful management of CMV pneumonia in a mechanically ventilated patient.Chest. 1991 Sep;100(3):856-8. doi: 10.1378/chest.100.3.856. Chest. 1991. PMID: 1653682
-
Cytomegalovirus prophylaxis and treatment following bone marrow transplantation.Ann Pharmacother. 1996 Nov;30(11):1277-90. doi: 10.1177/106002809603001113. Ann Pharmacother. 1996. PMID: 8913411 Review.
-
Cytomegalovirus pneumonia: presentation, diagnosis, and treatment.Semin Respir Infect. 1995 Dec;10(4):209-15. Semin Respir Infect. 1995. PMID: 8668848 Review.
Cited by
-
Prevention and treatment of CMV infection after allogeneic bone marrow transplant.Ann Hematol. 1992 Jun;64 Suppl:A158-61. doi: 10.1007/BF01715372. Ann Hematol. 1992. PMID: 1322189
-
Activity of the anti-HIV agent 9-(2-phosphonyl-methoxyethyl)-2,6-diaminopurine against cytomegalovirus in vitro and in vivo.Eur J Clin Microbiol Infect Dis. 1993 Jun;12(6):437-46. doi: 10.1007/BF01967438. Eur J Clin Microbiol Infect Dis. 1993. PMID: 8395382
-
Bone marrow transplantation using unrelated donors for haematological malignancies.Med Oncol. 1997 Mar;14(1):11-22. doi: 10.1007/BF02990940. Med Oncol. 1997. PMID: 9232606 Review.
-
Factors associated with cytomegalovirus reactivation following allogeneic hematopoietic stem cell transplantation: human leukocyte antigens might be among the risk factors.Turk J Haematol. 2014 Sep 5;31(3):276-85. doi: 10.4274/tjh.2013.0244. Turk J Haematol. 2014. PMID: 25330521 Free PMC article.
-
Inactivation of human cytomegalovirus by sodium periodate oxidation.Arch Virol. 1994;135(1-2):61-74. doi: 10.1007/BF01309765. Arch Virol. 1994. PMID: 8198450