Successful treatment of cytomegalovirus pneumonitis with ganciclovir and high-dose intravenous immunoglobulin in a bone marrow transplant recipient.

A 35-year-old man with acute lymphoblastic leukemia in second remission received an allogeneic bone marrow transplant from an HLA-compatible sibling donor. Unfortunately, cytomegalovirus (CMV) pneumonitis was histologically documented on Day +72. Combination therapy with ganciclovir (9-[2-hydroxy-1-(hydroxy-methyl) ethoxymethyl] guanine) and high-dose intravenous immunoglobulin (IVIG) was started immediately. The treatment comprised a three-week induction course (ganciclovir, 2.5 mg/kg q8h and IVIG, 500 mg/kg qod) and a seven-week fixed-dose maintenance course (ganciclovir 5 mg/kg thrice a week for 20 doses and IVIG 500 mg/kg twice a week for eight doses). The pneumonia resolved gradually, and he was free from symptoms within two weeks. The only significant side effect was moderately severe myelosuppression which was reversible after discontinuation of ganciclovir. The patient had a relapse of leukemia on Day +186, but there was no recurrence of CMV pneumonitis. This result confirms that such combination therapy is effective in the treatment of CMV pneumonitis in a patient with a bone marrow transplant.