Treatment and prevention of cytomegalovirus pneumonia after bone marrow transplantation: where do we stand?

T HE FOUR PROBLEMS that still limit the overall success of allogeneic bone marrow transplantation (BMT) are regimen-related toxicity, recurrent leukemia, graft-versus-host disease (GVHD), and cytomegalovirus (CMV) infection. The last 5 years have seen considerable progress in improving the treatment and prevention of GVHD and decreasing leukemic relapse.' Until recently, cytomegalovirus was a major cause of morbidity and mortality after allogeneic BMT and, among patients who were seropositive, approximately 15% to 20% of the deaths occurring after transplant could be attributed to CMV disease of the lung.' The recent substantial progress in the approach to CMV involves not only the treatment but also the prevention of CMV-associated pneumonitis (CMV-IP). Nevertheless, despite these improvements in patient management, the control of CMV remains less than optimal. This review summarizes the progress to date and describes future strategies for prevention of CMV-related complications of BMT.