To describe characteristics and clinical outcomes of hematopoietic stem cell transplant (HSCT) patients who received adjunctive Cytomegalovirus Intravenous Immune Globulin (CMV-IVIG) for probable or proven cytomegalovirus (CMV) disease.
Retrospective cohort study.
A large, university-affiliated, tertiary-care medical center.
Thirty-five adult HSCT patients receiving at least one dose of CMV-IVIG for adjunctive treatment of probable or proven CMV disease over an eight-year period.
Measurements and Main Results
All-cause mortality at hospital discharge was the primary outcome. All patients received an allogeneic HSCT. Twenty-six patients had pneumonitis (74%), nine had enteritis (26%), and 29 had CMV viremia (83%). All patients received concomitant antiviral therapy; 31 (89%) received ganciclovir and 14 (40%) received foscarnet. All-cause mortality at hospital discharge was 49%. Patient characteristics associated with mortality included requiring intubation for CMV pneumonia (79% of non-survivors vs. 25% of survivors, p=0.016) and earlier disease onset following HSCT (median of 48 days for non-survivors vs. 106 days for survivors, p<0.001). In multivariable analysis, only requiring intubation for CMV pneumonia remained a significant risk factor for increased mortality. CMV-IVIG was attributed with a low rate of adverse events; mild hypertension (5.7%) and erythema/chills (2.9%) were most common.
The mortality rate in our population is similar to previous reports in the literature, and may be somewhat lower than rates reported with antiviral monotherapy. Our analysis suggests that factors associated with mortality include the need for intubation and, possibly, earlier onset of CMV disease following HSCT. CMV-IVIG appears to be well-tolerated in HSCT patients. These findings support further trials of CMV-IVIG efficacy in this setting.