Treatment of cytomegalovirus disease.

Cytomegalovirus (CMV) infection, particularly CMV pneumonitis, continues to be an important infectious complication following allogeneic bone marrow transplantation. Most bone marrow transplant (BMT) centers have reported an overall incidence of CMV pneumonitis of 15% to 20%. Until recently, the mortality rate from CMV pneumonitis has been extremely high (greater than 80%). Historically, both single-agent therapy and combination treatments have failed to increase survival of BMT recipients with CMV pneumonia. The introduction of new antiviral agents with potent activity against CMV in vitro, such as ganciclovir and trisodium phosphonoformate, seemed to offer promise for improving survival. However, as single agents, a significant impact on mortality has not been achieved with either. The addition of high-dose intravenous immunoglobulin (IVIG) to ganciclovir appears to have a significant impact on mortality due to CMV pneumonia following bone marrow transplantation. The mechanism by which IVIG exerts its clinical effect remains to be determined, and a better understanding of the underlying process may improve this approach in the future. Bone marrow toxicity associated with ganciclovir remains a particular problem in the BMT population. Strategies to circumvent this problem, such as the use of hematopoietic stem cell growth factors or the use of an agent that is less bone marrow suppressive, such as phosphonoformate, may also increase the effectiveness of treating CMV pneumonia.