Reduced Mortality of Cytomegalovirus Pneumonia After Hematopoietic Cell Transplantation Due to Antiviral Therapy and Changes in Transplantation Practices
Details
Serval ID
serval:BIB_6EE653C868A5
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Reduced Mortality of Cytomegalovirus Pneumonia After Hematopoietic Cell Transplantation Due to Antiviral Therapy and Changes in Transplantation Practices
Journal
Clin Infect Dis
ISSN
1537-6591 (Electronic)
ISSN-L
1058-4838
Publication state
Published
Issued date
2015
Volume
61
Number
1
Pages
31-9
Language
english
Notes
Erard, Veronique
Guthrie, Katherine A
Seo, Sachiko
Smith, Jeremy
Huang, MeeiLi
Chien, Jason
Flowers, Mary E D
Corey, Lawrence
Boeckh, Michael
eng
P01 CA018029/CA/NCI NIH HHS/
P30 CA015704/CA/NCI NIH HHS/
CA 15704/CA/NCI NIH HHS/
K24HL093294/HL/NHLBI NIH HHS/
K24 HL093294/HL/NHLBI NIH HHS/
CA 18029/CA/NCI NIH HHS/
Clinical Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Clin Infect Dis. 2015 Jul 1;61(1):31-9. doi: 10.1093/cid/civ215. Epub 2015 Mar 16.
Guthrie, Katherine A
Seo, Sachiko
Smith, Jeremy
Huang, MeeiLi
Chien, Jason
Flowers, Mary E D
Corey, Lawrence
Boeckh, Michael
eng
P01 CA018029/CA/NCI NIH HHS/
P30 CA015704/CA/NCI NIH HHS/
CA 15704/CA/NCI NIH HHS/
K24HL093294/HL/NHLBI NIH HHS/
K24 HL093294/HL/NHLBI NIH HHS/
CA 18029/CA/NCI NIH HHS/
Clinical Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Clin Infect Dis. 2015 Jul 1;61(1):31-9. doi: 10.1093/cid/civ215. Epub 2015 Mar 16.
Abstract
BACKGROUND: Despite major advances in the prevention of cytomegalovirus (CMV) disease, the treatment of CMV pneumonia in recipients of hematopoietic cell transplant remains a significant challenge. METHODS: We examined recipient, donor, transplant, viral, and treatment factors associated with overall and attributable mortality using Cox regression models. RESULTS: Four hundred twenty-one cases were identified between 1986 and 2011. Overall survival at 6 months was 30% (95% confidence interval [CI], 25%-34%). Outcome improved after the year 2000 (all-cause mortality: adjusted hazard ratio [aHR], 0.7 [95% CI, .5-1.0]; P = .06; attributable mortality: aHR, 0.6 [95% CI, .4-.9]; P = .01). Factors independently associated with an increased risk of all-cause and attributable mortality included female sex, elevated bilirubin, lymphopenia, and mechanical ventilation; grade 3/4 acute graft-vs-host disease was associated with all-cause mortality only. An analysis of patients who received transplants in the current preemptive therapy era (n = 233) showed only lymphopenia and mechanical ventilation as significant risk factors for overall and attributable mortality. Antiviral treatment with ganciclovir or foscarnet was associated with improved outcome compared with no antiviral treatment. However, the addition of intravenous pooled or CMV-specific immunoglobulin to antiviral treatment did not seem to improve overall or attributable mortality. CONCLUSIONS: Outcome of CMV pneumonia showed a modest improvement over the past 25 years. However, advances seem to be due to antiviral treatment and changes in transplant practices rather than immunoglobulin-based treatments. Novel treatment strategies for CMV pneumonia are needed.
Keywords
Adolescent, Adult, Aged, Antiviral Agents/*therapeutic use, Child, Child, Preschool, Cohort Studies, Cytomegalovirus Infections/*drug therapy/*mortality, Female, Hematopoietic Stem Cell Transplantation/*adverse effects, Humans, Incidence, Infant, Male, Middle Aged, Pneumonia, Viral/*drug therapy/*mortality, Survival Analysis, Young Adult, T-cell therapy, antiviral treatment, cytomegalovirus, hematopoeitic cell transplantation, immunoglobulin, pneumonia
Pubmed
Create date
25/02/2022 15:43
Last modification date
26/02/2022 6:35