CMV pneumonia in adult autologous blood and marrow transplant recipients

We reviewed the frequency, timing, and outcome of CMV pneumonia (+ BAL) in 795 adult autologous blood and marrow transplant recipients at MDACC between 5/92 and 5/96. The overall frequency was 1.9% (15/795) with a mortality of 27% (4/15). The underlying disease / # of CMV pneumonias / # of deaths was: breast ca. (290 / 2 / 0); lymphoma (215/6/2); myeloma (65 / 5 / 1 ); CML (36 / 1 / 0) and ALL (7 / 1 / 1). Eleven pneumonias occurred early (<30 d) and 4 occurred late (> 100-<365 d ) post-transplant. Seven of 8 pts treated before respiratory failure survived; 0 of 2 pts treated after respiratory failure survived; and 4 of 5 untreated pts survived. Three of 4 pneumonias occuring late post-transplant resolved without antiviral therapy, as did both pneumonias in pts with breast ca. (1 early + 1 late post-transplant). Thirteen other pts had CMV viremia (mean: 33 d; range: 13-68 d post-transplant) associated with fever (n=3); hepatitis (n = 3) and pneumonia (n = 7). All 13 pts were treated with GCV or foscarnet and all but 2 survived. In conclusion, CMV is a potentially life-threatening cause of pneumonia in autologous blood and marrow transplant recipients, especially early post-transplant. Its occurrence appears to be in part related to the underlying immunodeficiency, ranging from < 1% with breast ca to 8% with myeloma and 14% with ALL. A favorable response hinges on the prompt initiation of therapy. The survival of 4 untreated pts with pneumonia suggests that the isolation of CMV from a BAL may occasionally reflect oropharyngeal contamination or that CMV pneumonia may occasionally be self-limited in more immunologically intact pts.