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Treatment of Cytomegalovirus Pneumonia with Ganciclovir and Intravenous Cytomegalovirus Immunoglobulin in Patients with Bone Marrow Transplants

Elizabeth C. Reed, MD; Raleigh A. Bowden, MD; Paula S. Dandliker, MSN; Kathryn E. Lilleby, RN; and Joel D. Meyers, MD
[+] Article and Author Information

Grant Support: Supported in part by a grant from Cutter Biological, Division of Miles Inc. , and by grants CA 18029, CA 26966, HL 36444, and CA 15704 from the National Institutes of Health. Dr. Reed was supported in part by a grant from the Poncin Scholarship Fund.

Requests for Reprints: Joel D. Meyers, MD, Fred Hutchinson Cancer Research Center, 1124 Columbia Street, Seattle, WA 98104.

Current Author Addresses: Dr. Reed: University of Nebraska Medical Center, 42nd Dewey, Omaha, NE 68105-1065.

Drs. Bowden, Meyers, and Ms. Lilleby: Fred Hutchinson Cancer Research Center, 1124 Columbia Street, Seattle, WA 98104. Ms. Dandliker: 8470 Inverness Drive, NE, Seattle, WA 98115.

© 1988 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1988;109(10):783-788. doi:10.7326/0003-4819-109-10-783
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Study Objective: To determine if the combination of ganciclovir and intravenous cytomegalovirus immunoglobulin is effective in patients with cytomegalovirus pneumonia after bone marrow transplant.

Design: Consecutive entry trial with treatment for a minimum of 14 days.

Patients: Consecutive sample of 25 patients with bone marrow transplants and cytomegalovirus pneumonia after transplant proven by open lung biopsy or bronchoalveolar lavage. Patients with abnormal renal function or concomitant infectious causes of pneumonia, or who were respirator-dependent at diagnosis, were not eligible.

Interventions: Induction treatment consisted of ganciclovir, 2. 5 mg/kg body weight every 8 hours for 14 days, and cytomegalovirus immunoglobulin, 400 mg/kg on days 1, 2, and 7 and 200 mg/kg on day 14. Ganciclovir dosage was adjusted for renal function. Patients who were improved but still symptomatic after 14 days were given maintenance treatment consisting of ganciclovir, 5 mg/kg once daily for an additional 14 days, and immunoglobulin, 200 mg/kg on day 21. Patients with clinical deterioration continued to receive induction doses. Ganciclovir therapy was discontinued if the neutrophil count fell below 500 X 106/L for 2 consecutive days.

Measurement and Main Results: Serial tests of renal and liver function, blood counts, and viral cultures of blood, throat, and urine were obtained 3 times a week. Thirteen of twenty-five (52%) patients (95% CI, 31 to 72) survived the initial episode of pneumonia. Viral excretion ceased in 17 of 23 (74%) patients treated more than 96 hours. Proven recurrences of pneumonia occurred in 3 patients and possible recurrences in 2 after treatment was stopped. Three patients developed neutropenia during induction therapy and 6 patients during maintenance therapy.

Conclusions: Survival of 13 (52%) of 25 patients from the initial episode of cytomegalovirus pneumonia with the regimen of ganciclovir and cytomegalovirus immunoglobulin is significantly better (P < 0. 001) than the survival of 13 of 89 (15%) patients using previous antiviral regimens.





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