GANCICLOVIR FOR THE TREATMENT OF DISSEMINATED CMV DISEASE WITHOUT PNEUMONIA IN ALLOGENEIC T-LYMPHOCYTE DEPLETED BONE-MARROW TRANSPLANTATION

Treatment with ganciclovir was assessed in 13 patients who underwent a llogeneic T-lymphocyte depleted bone marrow transplantation (BMT) for a variety of malignant hematological disorders and subsequently develo ped severe cytomegalovirus (CMV) disease without pneumonia. The manife stations of CMV disease appeared on days 23-105 (median 51) post BMT, and included gastrointestinal symptoms, weight loss, fever, disturbed liver function, leukopenia and thrombocytopenia. Ganciclovir was admin istered for 14 days, without the addition of intravenous immunoglobuli ns. Following therapy, the clinical manifestations subsided in most of the patients, while leukopenia, thrombocytopenia and liver dysfunctio n resolved in about half of the patients. One patient who experienced recurrent CMV responded to a second course of ganciclovir. Poor respon se to ganciclovir treatment was observed in 2 of the 3 patients with g rade 4 graft-versus-host disease (GVHD). Our experience suggests that a 2-week course of ganciclovir may be effective in BMT recipients who develop severe CMV-associated disease without lung involvement, especi ally when there is no concommitant severe GVHD.