Clinical efficacy of adenine arabinoside in therapy of cytomegalovirus infections in renal allograft recipients

Abstract

Three renal allograft recipients, two with cytomegalovirus pneumonia and one with cytomegalovirus retinitis, were treated with adenine arabinoside. The dose was 5-10 mg/kg per day administered for four to six days. There was no clinical improvement in any of the patients. One patient died from overwhelming interstitial viral pneumonia. Cytomegalovirus was readily isolated from two patients after therapy (autopsied lung of one and the saliva of the other). Suppression of viruria was observed and quantitated in one patient (10(4.0)-10(2.5) 50% tissue culture infective doses/0.2 ml). However, the suppression was transient, and viral titers returned to the levels before therapy within two months after completion of therapy. Treatment was stopped in two cases when hematologic toxicity (drop in hematocrit and platelet and leukocyte counts) was noted in the patients five days after initiation of therapy with adenine arabinoside. The drug appears to be ineffective and possibly toxic in immunosuppressed renal allograft recipients infected with cytomegalovirus.