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Management of human cytomegalovirus infection and disease after allogeneic bone marrow transplantation.
Haematologica. 1999 Jan; 84(1):71-9.H

Abstract

BACKGROUND AND OBJECTIVE

Human cytomegalovirus (HCMV) infection and disease remain a major cause of morbidity and mortality after bone marrow transplantation. HCMV disease, especially pneumonitis, may be treated with ganciclovir and immunoglobulin but even so the outcome is poor with mortality rates of 30-70%. It is therefore imperative to treat HCMV infection before it develops into disease. The aim of this article is to describe the main strategies used to prevent HCMV infection and to improve the survival after CMV disease in bone marrow transplant recipients.

INFORMATION SOURCES

In the present review, we examined personal papers in this field and articles published in journals covered by the Science Citation Index and Medline.

STATE OF THE ART

Major advances have been made in preventing HCMV infection and disease through two different approaches, both of which reduce HCMV induced morbidity and mortality: In pre-emptive therapy, patients are given ganciclovir when HCMV infection is first identified and this is continued 3-4 months after transplantation; in prophylactic therapy ganciclovir is given to all patients at risk of HCMV disease from engraftment up to 3-4 months post transplantation. Each strategy has advantages and disadvantages and there is no evidence for the superiority of one over the other since the overall survival is the same and the incidence of death from HCMV disease is similar.

PERSPECTIVES

The use of more sensitive tests such as HCMV PCR or antigenemia may improve the outcome but probably will not eradicate all HCMV disease. Future possible strategies could include adoptive transfer of CD8+ HCMV-specific cytotoxic T lymphocytes clones derived from the donor marrow or boosting donor or patient immunity using subunit anti-HCMV vaccines such as gB or pp65.

Authors+Show Affiliations

Department of Medical and Morphological Research, University Hospital, Udine, Italy. ematologia@drmm.uniud.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

10091394

Citation

Stocchi, R, et al. "Management of Human Cytomegalovirus Infection and Disease After Allogeneic Bone Marrow Transplantation." Haematologica, vol. 84, no. 1, 1999, pp. 71-9.
Stocchi R, Ward KN, Fanin R, et al. Management of human cytomegalovirus infection and disease after allogeneic bone marrow transplantation. Haematologica. 1999;84(1):71-9.
Stocchi, R., Ward, K. N., Fanin, R., Baccarani, M., & Apperley, J. F. (1999). Management of human cytomegalovirus infection and disease after allogeneic bone marrow transplantation. Haematologica, 84(1), 71-9.
Stocchi R, et al. Management of Human Cytomegalovirus Infection and Disease After Allogeneic Bone Marrow Transplantation. Haematologica. 1999;84(1):71-9. PubMed PMID: 10091394.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of human cytomegalovirus infection and disease after allogeneic bone marrow transplantation. AU - Stocchi,R, AU - Ward,K N, AU - Fanin,R, AU - Baccarani,M, AU - Apperley,J F, PY - 1999/3/26/pubmed PY - 1999/3/26/medline PY - 1999/3/26/entrez SP - 71 EP - 9 JF - Haematologica JO - Haematologica VL - 84 IS - 1 N2 - BACKGROUND AND OBJECTIVE: Human cytomegalovirus (HCMV) infection and disease remain a major cause of morbidity and mortality after bone marrow transplantation. HCMV disease, especially pneumonitis, may be treated with ganciclovir and immunoglobulin but even so the outcome is poor with mortality rates of 30-70%. It is therefore imperative to treat HCMV infection before it develops into disease. The aim of this article is to describe the main strategies used to prevent HCMV infection and to improve the survival after CMV disease in bone marrow transplant recipients. INFORMATION SOURCES: In the present review, we examined personal papers in this field and articles published in journals covered by the Science Citation Index and Medline. STATE OF THE ART: Major advances have been made in preventing HCMV infection and disease through two different approaches, both of which reduce HCMV induced morbidity and mortality: In pre-emptive therapy, patients are given ganciclovir when HCMV infection is first identified and this is continued 3-4 months after transplantation; in prophylactic therapy ganciclovir is given to all patients at risk of HCMV disease from engraftment up to 3-4 months post transplantation. Each strategy has advantages and disadvantages and there is no evidence for the superiority of one over the other since the overall survival is the same and the incidence of death from HCMV disease is similar. PERSPECTIVES: The use of more sensitive tests such as HCMV PCR or antigenemia may improve the outcome but probably will not eradicate all HCMV disease. Future possible strategies could include adoptive transfer of CD8+ HCMV-specific cytotoxic T lymphocytes clones derived from the donor marrow or boosting donor or patient immunity using subunit anti-HCMV vaccines such as gB or pp65. SN - 0390-6078 UR - https://www.unboundmedicine.com/medline/citation/10091394/Management_of_human_cytomegalovirus_infection_and_disease_after_allogeneic_bone_marrow_transplantation_ L2 - http://www.diseaseinfosearch.org/result/7171 DB - PRIME DP - Unbound Medicine ER -