A clinician’s plea to test glioma patients for CMV

Abstract

during therapy: 19/26 patients were positive for anti-CMV IgG at all serum collection time points (Table 1). Only 3/26 patients were positive for anti-CMV IgM and those were also positive for anti-CMV IgG, indicating a reactivation rather than a primary CMV infection. None of the patients was positive for CMV DNA in peripheral blood despite use of a highly sensitive PCR assay. 3 Nineteen of 26 patients received dexamethasone during RT, 4 patients before RT but stopped during RT, and 3 patients did not receive dexamethasone. The mean cumulative dosage of dexamethasone before RT was 228.0 mg (SD 80.9 mg) in the CMV IgM-positive patients and 180.2 mg (SD 175.3 mg) in the CMV IgM-negative patients (Mann-Whitney U test P = 0.259). The cumulative dosage of dexamethasone during RT was similar between these 2 patient groups-188.7 mg (SD 151.1) versus 111.4 mg (SD 100.8) (Mann-Whitney U test P = 0.313) and 4.5 mg per day (SD 3.4) versus 4.0 (SD 3.6) (Mann Whitney U Test P = 0.491). Of note, lower dosages of the corticosteroid were administered at all time points compared with the prior study. 1 Glucocorticoids play an important role in CMV replication: dexamethasone treatment of fibroblasts enhances replication of CMV 4 and initiates the transcription cascade of CMV. 5 In concordance, Goerig et al 1 found an association between CMV reactivation and dexamethasone treatment of glioblastoma patients. In contrast, we didn't find an association between RT or dexamethasone treatment and CMV reactivation. None of our patients had CMV viremia and only 3 patients were positive for anti-CMV IgM during treatment. Nevertheless, glucocorticoid dosages used in the present patients were clearly lower than in the previous study. Standard glucocorticoid dosages used in the treatment of glioblastoma may have to be optimized to reduce the risk of CMV reactivation and disease.

Viral Oncogenesis in Tumors of the Central Nervous System: Reality or Random Association? A Retrospective Study on Archived Material

“…Emerging evidence demonstrated the presence of human CMV proteins and nucleic acids in brain tumors in both adults and children [23], detecting the virus presence particularly in patients with high-grade gliomas (Ranganathan et al 2012; Goerig et al 2017). However, data are contrasting and the need for research into the involvement of this virus in gliomas has recently been argued [25,26] since the CMV presence seems to be limited only to glioblastoma and not present in other types of glial tumors.…”