Cytomegalovirus Disease in Children With Acute Lymphoblastic Leukemia in the Nontransplant Setting

Abstract

Cytomegalovirus (CMV) disease in pediatric acute lymphoblastic leukemia in the nontransplant setting is very rare. We report our experience with 4 such cases, and review the literature (n=12). The median age at diagnosis was 10 years and 50% of patients were males. Among the 11 cases with available information at the time of diagnosis, CMV disease occurred during maintenance therapy in 10 patients. Fever was present in 9 cases. CMV disease manifested as retinitis in 6, hepatosplenic disease in 3, pneumonitis in 1, and hemophagocytic lymphohistiocytosis in 1 patient. One patient had both CMV retinitis and CMV-related hemophagocytic lymphohistiocytosis. Four of the 7 patients with retinitis complained of visual disturbance at diagnosis. CMV viremia was present in 10 patients. Three patients had at least 1 relapse and developed permanent visual defects, and 1 patient developed recurrent retinal detachment. In conclusion, prolonged immunosuppression is the major etiology and retinitis is the most common manifestation of CMV disease. As a significant number of patients with retinitis are asymptomatic, early diagnosis and treatment is important to prevent permanent visual loss.

Cytomegalovirus disease in children with acute lymphoblastic leukemia

“…In addition, relapse of CMV infection was documented in 27% patients. Low ALC was cited as a reason for CMV infection [23]. Although children on maintenance are not on intensive chemotherapy, they do receive steroids every month.…”

Infectious complications in children with acute lymphoblastic leukemia treated in low-middle-income countries

“…After primary infection, CMV can remain latent and symptomatic reactivation occurs in severely immunosuppressed patients, that is, transplants. In an Iranian case series, 12 ALL patients not receiving transplant developed CMV infection, of whom 11 acquired infection in the maintenance phase of chemotherapy [90]. Viremia, retinitis and hepatosplenic disease were common manifestations.…”

Acute Progressive Visual Loss in a Case of Acute Myeloid Leukemia: Challenges in the Utility of Molecular Tests in Early Diagnose of Cytomegalovirus Retinitis

“…Although CMV retinitis is less common than other etiologic causes of acute visual loss in acute leukemia [17–19], high level of suspicion, timely diagnosis, and prompt treatment could prevent permanent visual loss [19]. …”

“…Although available data have been confirmed direct association between high CMV viral load and development of CMV retinitis in patients with CMV viremia after hematopoietic stem cell transplantation (HSCT) [24], there is lack of enough evidence to support this relationship in leukemia. Based on small case series, nearly all reported cases had viremia at the time of diagnosis [19]. Antiviral therapy usually is continued for 4–6 weeks.…”