Cytomegalovirus pneumonia in adult autologous blood and marrow transplant recipients

CMV pneumonia is a major cause of morbidity and mortality among allogeneic BMT recipients. To assess the frequency, timing, risk factors and response to therapy of CMV pneumonia among autologous BMT recipients, we reviewed ou r experience with 795 patients. Sixteen (2%) patients were diagnosed with C MV pneumonia, The frequency was higher among patients who were seropositive than those who were seronegative (3.3% vs 0%, P = 0.008). Among seropositi ve patients, the frequency was higher among patients with hematological mal ignancies than patients with solid tumors (5.0 % vs 1.0%, P = 0.019). Eleve n cases occurred <30 days, and five cases occurred >100 days post transplan t. The overall CMV pneumonia-related mortality rate was 31%. Seven (78%) of nine patients treated with ganciclovir and IVIG prior to respiratory failu re survived; neither of two patients treated after respiratory failure surv ived. Four of five (80%) untreated patients survived. In conclusion, CMV is a not infrequent cause of pneumonia among autologous BMT recipients. Risk factors include CMV seropositivity and an underlying hematological malignan cy. A favorable response hinges on the prompt initiation of therapy. The su rvival of 25% of the patients without antiviral therapy suggests that the i solation of CMV from a BAL specimen occasionally reflects oropharyngeal con tamination or that CMV pneumonia may sometimes be self-limited in more immu nocompetent autologous BMT recipients.