Incidence of cmv infection and cmv disease in allogeneic transplanted patients: From no prophylaxis to preemptive treatment

During the last decade, CMV prophylaxis and preemptive therapy has considerably changed the outcome of CMV seropositive patients (pts). We have thus reviewed retrospectively our experience in 138 AlloBMT from 1984 to 2000 according to our anti CMV policy that evolved from no prophylaxis (1984–1990) to IVIG and acyclovir prophylaxis (1990–1995) and finally to prophylaxis and PCR based preemptive therapy with gancyclovir and IVIG (1995 to present). First period: 32 adult pts were allografted, 27 (72%) were CMV+, 7 pts (22%) developed a CMV disease (CMVD): 4 interstitial pneumonitis (IP), 2 pancytopenia and 1 pancytopenia with IP. Five (71%) died from CMVD (100% mortality for IP). Second period: 36 pts were allografted, 26 (72%) were CMV positive. Pts were treated for CMV infection when a positive sample by immunofluorescence or culture was reported. 4 pts (11%) were treated : 1 pancytopenia with retinitis, 2 IP and 1 skin infection with pancytopenia. 1 pt died (25%) from IP. Third period: 70 pts were allografted. PCR were monitored biweekly during 3 months after BMT. After 2 positive PCR tests on buffy coat, pts were preemptly treated. 17 pts (24%) received a preemptive treatment for positive PCR on buffy coat. 9 pts have positive PCR and cytopenia. 7 pts (10%) developed CMVD: 2 IP, 2 retinitis, 1 colitis, 1 oophoritis and 1 pt died from generalized CMVD. Those 7 pts had MUD. The pt who died from CMVD was allografted with an unrelated T depleted BM. In the setting of familial allo BMT, CMV disease is no longer a major complication in contrast with MUD.