Cytomegalovirus disease in children with acute lymphoblastic leukemia

Abstract

Viral infections are an underrecognized problem in children on standard chemotherapy for acute lymphoblastic leukemia (ALL). In countries with high baseline seroprevalence of cytomegalovirus (CMV) such as India, it may be an important pathogen leading to fever, end-organ damage, and cytopenia. Data regarding the incidence and manifestations of CMV disease in pediatric ALL patients are scanty. The authors prospectively assessed all children on chemotherapy for ALL with prolonged febrile neutropenia (FN) for CMV disease over a 3-year period. Children with end-organ damage, including pneumonia, retinitis, and colitis, were also evaluated. Quantitative and qualitative polymerase chain reaction (PCR) from blood, body fluids, or tissue was done along with ophthalmologic evaluation. CMV disease was detected in 10% of the children with prolonged FN. In addition, other children were identified due to end-organ damage, lung and eye being the common organs of involvement. Time of CMV reactivation was essentially during nonintense phase of chemotherapy. Lymphopenia was present in most children, and prolonged lymphopenia was associated with relapse of CMV infection after therapy. The authors conclude that CMV is an important pathogen in children on standard chemotherapy for ALL. It has a good outcome with early detection and directed therapy. Parenteral ganciclovir is needed for a period of 14-21 days to prevent recurrence.

Cytomegalovirus Disease in Children with Acute Lymphoblastic Leukemia: A case series study

“…In one study, CMV antigenemia for hematologic malignancies had been shown at a rate of %11 (6) . Jain et al (2) had found a 10% risk of CMV infection in their study performed in children with ALL and prolonged febrile neutropenia. Thirteen of fourteen patients in our study had positive CMV IgG results which were considered as reactivation of CMV.…”

“…Cytomegalovirus disease may have nonspecific manifestations as fever, malaise, abnormal blood counts, elevated transaminases; and also serious outcomes like hepatitis, colitis, pneumonitis, retinitis or even death in immunocompromised patients. In the literature, fever had been shown as the most common symptom of CMV disease in children with ALL (2,3) . In our study, fever (64%) was found as the most common symptom supporting previous studies.…”

“…In our study, fever (64%) was found as the most common symptom supporting previous studies. Especially in the presence of prolonged febrile neutropenia persisting for more than 7 days, CMV should be kept in mind in the differential diagnosis (2,3,7) . Neutropenia and thrombocytopenia associated with CMV infection in children with ALL receiving standard chemotherapy were also reported in an article (8) .…”

“…Whatever the primary disease is, T-cell mediated immune dysfunction plays an important role in the pathogenesis of severe CMV infections. The studies on CMV infection in immunosuppressed patients are generally based on well-demonstrated conditions such as HSCT and SOT, however, there are limited studies about incidence and manifestations of CMV in children with ALL receiving standard chemotherapy (2,3) . Here we report our clinical experience with fourteen ALL patients that had CMV disease as detected during their monitorization.…”

Viral Pneumonia in Patients with Hematopoietic Cell Transplantation and Hematologic Malignancies

“…34,36,[39][40][41][42][43] CMV pneumonia is much less common in patients who have received an autologous transplant, or in patients receiving treatment of HM with incidence of 1% to 5% reported in the absence of surveillance and preemptive therapy. [44][45][46][47][48] Treatment Ganciclovir (5 mg/kg intravenous [IV] every 12 hours) remains the first-line treatment for CMV pneumonitis. 49 Based on the results of three nonrandomized studies, [50][51][52] CMV immunoglobulin was often recommended as adjunctive treatment.…”