SHOULD CYTOMEGALOVIRUS BE TESTED FOR IN BOTH BLOOD AND BRONCHOALVEOLAR LAVAGE FLUID OF PATIENTS AT A HIGH-RISK OF CMV PNEUMONIA AFTER BONE-MARROW TRANSPLANTATION

To identify and treat patients at high risk of cytomegalovirus (CMV) p neumonia after bone marrow transplantation (BMT), we tested for CMV vi raemia weekly, and performed broncho-alveolar lavage (BAL) on day 35 p ost-transplant in 63 recipients. 36 allogeneic BMT recipients were at a high risk of CMV pneumonia (25 CMV-seropositive recipients and 11 pa tients receiving marrow from a CMV-seropositive donor). Patients with a positive BAL or viraemia received a 14 d course of ganciclovir or fo scarnet. CMV was detected in 29 (46%) of the 63 BMT recipients and exc retion of CMV in blood and BAL was significantly linked. However, amon g the 29 patients who excreted the virus, only 10 (35%) shed CMV in bl ood BAL at the same time; 19 patients (65%) had detectable CMV in bloo d (11 patients) or BAL (eight patients) only. Therefore, on the of vir aemia or BAL alone, 21/29 patients (70%) and 18/29 patients (60%), res pectively, would have received antiviral treatment. BAL increased the CMV detection rate by 13% (8/63 patients) relative to viraemia. With t his strategy, the incidence of CMV pneumonia was reduced to 3% in allo grafted patients. Only two of the 19 autografted patients developed fa tal CMV pneumonia. We avoided anti-CMV treatment in 54% of all the BMT recipients. In conclusion, CMV should be tested for in both blood and BAL fluid of BMT recipients at high risk of CMV pneumonia.