Autologous Bone Marrow Transplantation - Blog Science Connections

Herpesvirus Infections After Autologous Bone
Marrow Transplantation
John R. Wingard, William H. Burns, and Rein Saral
Herpesvirus infections impose substantial morbidity and mortality after allogeneic
bone marrow transplantation. Detailed studies of herpesvirus infections
after autologous bone marrow transplantation (ABMT) have not been
published as yet. We have found reactivated herpes simplex virus (HSV)
infections in patients who have received allogeneic marrow and in intensively
treated patients with acute leukemia to be comparable in severity and timing
(1,2). Reactivation occurs in two thirds of HSV seropositive patients during
the third week after initiating cytotoxic therapy. The prophylactic use of
intravenously administered acyclovir completely suppresses reactivation of
the virus during administration of the drug. Because of the comparability of
patients who undergo ABMT to these other two patient populations, we
routinely use prophylactic acyclovir after ABMT to maximize antiviral efficacy
and to minimize emergence of resistant virus. This strategy employed at our
institution was reviewed previously at the first of these symposia (3).
We have reviewed our experience with cytomegalovirus (CMV) infection
in 143 consecutive patients who received ABMT over a 9-year period. Twentyseven
patients (19%) developed positive CMV cultures (Table 1). Seven
patients (5%) developed CMV viremia. No patient developed CMV retinitis, but
three (2%) developed CMV pneumonitis.
The incidence of CMV pneumonitis (2%) after ABMT was substantially
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