Autologous Bone Marrow Transplantation - Blog Science Connections

Herpesvirus Infections 611
Table 2. Comparison of CMV Infections in Patients Receiving Autologous and
Allogeneic Bone Marrow Transplantation
Type of Transplant
Allogeneic
Autologous
Infectious Indication No. (%) No (%)
Patients with positive pretransplant
serology/patients
tested 232/347 (67%) 94/134 (70%) P = NS
Patients with negative pretransplant
serology who
seroconverted 49/106 (46%) 18/37 (49%) P = NS
Patients with positive cultures/
Patients with:
Positive pre-BMT serology
(during first 50 days)
97/232
46/232
(42%)
(20%)
24/94
20/94
(26%)
(21%)
P = .009
P = NS
Negative pre-BMT serology
(during first 50 days)
15/115
7/115
(13%)
(6%)
2/40
2/40
(5%)
(5%)
P = .008
P = NS
Unknown pre-BMT serology
(during first 50 days)
7/39
5/39
(18%)
(13%)
1/9
1/9
(11%)
(11%)
P = .53
P = NS
Patients with viremia/Patients
with positive cultures
(during first 50 days)
49/119
23/58
(41%)
(40%)
7/27
5/23
(26%)
(22%)
P = .21
P = .20
Abbreviation: BMT, bone marrow transplantation.
more likely to have positive cultures than those with negative sera (P = .001
and P = .01, respectively).
These data support the conclusion that rates of reactivation of latent CMV
and new infection do not explain the difference in rates of CMV pneumonitis. A
plausible explanation for the difference in risk for CMV pneumonitis is the
difference in immunodeficiency after autologous compared to allogeneic
transplantation. This is supported by the finding that the frequency of CMV
pneumonia in allogeneic marrow recipients without acute graft-versus-host
disease (GVHD) (5%) was not significantly greater than the rate of CMV
pneumonia after ABMT (2%) (Table 3). In contrast, patients with acute GVHD
after allogeneic transplantation had a significantly higher rate of CMV pneumonia
than either autologous or allogeneic marrow recipients without acute
GVHD. This is presumably due to the immunodeficiency imposed by the
GVHD itself as well as the immunosuppressive therapy used to treat GVHD.
Several new approaches to serious CMV infection have been studied in
recent years. Cytomegalovirus immune plasma and immunoglobulin have
been studied in several patient populations after allogeneic marrow transplantation
(5-9). In general, such treatments have been beneficial in the