Late cytomegalovirus pneumonia in adult allogeneic blood and marrow transplant recipients

To assess the impact of antiviral prophylaxis during the first 3 months aft er transplantation on the frequency, timing, and outcome of cytomegalovirus (CMV) pneumonia during the first year, 541 adult allogeneic blood and marr ow transplant recipients were evaluated, Thirty-four patients (6.3%) develo ped 35 episodes of CMV pneumonia at a mean of 188 days after transplantatio n, with an associated mortality rate of 76%. Twenty-six episodes (74%) occu rred late (after day 100), Of the patients with late CMV pneumonia almost a ll (92%) had chronic graft vs. host disease or had received T cell-depleted transplants. Fourteen late CMV pneumonias (541) were associated with serio us concurrent infections, and 100%, of these episodes were fatal. In conclu sion, although the frequency of CMV pneumonia in the early posttransplantat ion period may be substantially reduced by prophylaxis, CMV continues to be a major cause of morbidity and mortality in the late period. Some subsets of patients need more prolonged surveillance and prophylaxis and/or preempt ive therapy.