Cytomegalovirus infection in patients with haematological diseases and after autologous stem cell transplantation as consolidation: a single-centre study

Abstract

Because of the widespread use of immunosuppressive drugs, CMV infection is one of the most important causes of morbidity and mortality in patients with haematological malignancies worldwide. The aim of the study was to retrospectively analyse the epidemiology of CMV infection in haematological patients. Between 2008 and 2014, 1238 quantitative CMV DNA detections from plasma specimens were performed. These specimens were collected from 271 patients with haematological malignancy. Patients were grouped on the basis of underlying diseases (lymphoid and myeloid malignancies and other haematological diseases). In the lymphoid and myeloid groups, we distinguished ASCT and non-ASCT groups. During the studied period, the majority of examined patients (82.6 %) were treated with lymphoproliferative disease. A total of 126 (46.5 %) patients underwent ASCT, while 145 (53.5 %) did not have stem cell transplantation. A total of 118 (9.5 %) of 1238 plasma specimens proved to be positive for CMV DNA; these specimens were collected from 66 (24.4 %) patients. Twenty-four (16.6 %) of 145 non-ASCT patients had CMV PCR positive specimens. Among non-ASCT patients with positive CMV PCR results, 10 patients were asymptomatic, 14 had symptomatic reactivation, while 2 had CMV disease. In the ASCT group, 42 (33.3 %) patients had CMV PCR positive samples. CMV reactivation was asymptomatic in 34 (81 %) cases, and 8 (19 %) patients had symptomatic reactivation. In the non-ASCT group, the rate of CMV infection is low. In the ASCT group, the prevalence of CMV infection was higher than in the non-ASCT group, but the majority of CMV infection was asymptomatic and only small number of patients had symptomatic reactivation. Thus, our results also showed that the use of routine CMV DNA monitoring is not necessary in patients with haematological malignancies not receiving fludarabine-containing regimen or alemtuzumab, in spite of this to decrease the mortality we have to consider the use of molecular tests in case of suspected infectious conditions.

Clinical experience with a novel assay measuring cytomegalovirus (CMV)-specific CD4+ and CD8+ T-cell immunity by flow cytometry and intracellular cytokine staining to predict clinically significant CMV events

“…Cytomegalovirus (CMV) infection remains one of the most prevalent opportunistic infections (OI) following solid organ transplantation (SOT), and in individuals with hematologic malignancies or other immunocompromising conditions [1][2][3]. It is associated with significant morbidity due to its direct (CMV disease) and indirect (other OI, rejection, chronic allograft dysfunction) effects [1,2,4].…”

Cytomegalovirus infection in hematologic malignancy settings other than the allogeneic transplant

“…Nevertheless, even though CMV reactivation still represents an important complication, most cases are successfully managed with a specific antiviral treatment (often administered within outpatient clinical settings). Still, though rare, CMV end‐organ disease remains a serious life‐threatening event in autografted patients, with an incidence up to 4% as reported throughout the last 20 years, although it is showing a trend toward a significant improvement when considering the more recent studies . Of note, overt CMV disease incidence and mortality appear similar irrespective to the diagnostic strategy adopted, further suggesting the limited usefulness of a prospective monitoring of CMV infection .…”

“…5,[42][43][44][45][46][47][48][49] Even though all these studies showed a significant reactivation rate of CMV infection in patients undergoing ASCT, CMV disease was a rare event, although representing a serious life-threatening risk, with a clinical course and mortality rates similar to those observed after allo-HSCT. 1 3,7,8,39,52,[54][55][56][57][58][59] Of note, overt CMV disease incidence and mortality appear similar irrespective to the diagnostic strategy adopted, further suggesting the limited usefulness of a prospective monitoring of CMV infection. 28 These findings are also in agreement with our recently updated results ( Table 5).…”

“…However, the recent large increase of an intensive use of pleiotropic immunosoppressive chemoimmunotherapy, particularly in lymphoproliferative disorders, has led to an increase of viral infections incidence in different hematologic patients. As a consequence, CMV represents an increasingly important pathogen in these patients, also in settings different from the allogeneic transplant and particularly so in specific clinical subsets . Based on these considerations, we performed a comprehensive review of the medical literature about CMV infection/reactivation in hematologic malignancies beyond allogeneic transplant.…”

Aktualitások a sérült immunitású betegek cytomegalovirusinfekcióinak ellátásában. I. Epidemiológia és klinikai szempontok

“…Az utóbbi 5 évben megjelent fontosabb tanulmányok szerint a hCMV-infekció a betegek 2,9-33,3%-át érinti, a hCMV-betegség azonban ritka [36]. Hazai adatok szerint rendszeres PCR-monitorozás mellett az autológtranszplantáltak egyharmadában lehet reaktivációt igazolni, ám tüneteket okozó fertőzés csak az érintettek 19%-ában jelentkezett [38,40]. Ha rutinszerű monitorozás, illetve profilaxis nem is indokolt, klinikai gyanú esetén gondolni kell potenciális veszélyes hCMVinfekció lehetőségére is.…”