Severe CMV reactivation and gastritis during treatment of follicular lymphoma with bendamustine

Lim, Seah H.; Pathapati, S.; Langevin, James M.; Hoot, Andrew

doi:10.1007/s00277-011-1307-z

Cited by 21 publications

(9 citation statements)

References 5 publications

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“…These studies strongly suggest that an impaired T‐cell immunity function, determined by Alemtuzumab, may represent a high risk factor for CMV infection/reactivation and that patients treated with this drug should be prospectively and carefully monitored. Furthermore, a large amount of clinical cases of life‐threatening CMV reactivation in hematologic malignancies as well as limited single‐centre experiences have been reported in the last few years, all suggesting a possible role of previous treatment with Rituximab, Bendamustine, and Bortezomib as predisposing factors for CMV infection/reactivation . Unfortunately, due to the heterogeneity of these data, gathered from a variety of different clinical settings, it is difficult to identify other concomitant risk factors for CMV reactivation with some reliability.…”

Section: Cytomegalovirus Infection In Nontransplanted Patientsmentioning

confidence: 99%

Cytomegalovirus infection in hematologic malignancy settings other than the allogeneic transplant

Marchesi¹,

Pimpinelli

Ensoli

et al. 2017

Hematological Oncology

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Cytomegalovirus (CMV) infection in clinical settings other than the allogeneic transplant represents a poorly explored issue. Thus, we performed a comprehensive review of the medical literature about CMV infection in patients undergoing autologous hematopoietic stem cell transplant and in other nontransplant-related hematologic patients. In autologous hematopoietic stem cell transplant, a CMV reactivation is reported to occur in up to 41% of CMV seropositive patients, when a prospective monitoring of antigenemia and/or viremia by polymerase chain reaction was adopted. However, more contained frequencies, up to 12%, have been reported when the monitoring criteria were based on a clinically driven diagnostic strategy. The most relevant risk factors appear to be CD34 + selected autografts, total body irradiation, and prior treatment with Alemtuzumab, Fludarabine, or Bortezomib, respectively. Other possible risk factors (ie, prior treatment with Rituximab, T-cell lymphomas, and pretransplant HBcIgG seropositivity) are still debated. In nontransplant settings, the data are very heterogeneous; thus, CMV infection incidence and risk factors are more difficult to establish. Overall, the rate of CMV infection/reactivation ranges between 2 and 67%. High-dose steroids, advanced disease, poor performance status, and treatment with Alemtuzumab, Fludarabine, Bortezomib, and Rituximab appear as the most relevant, though putative, risk factors. Intravenous Ganciclovir represents the gold standard for first-line treatment of CMV infection in these patients. Oral Valganciclovir and Foscarnet are other possible options. Extensive prophylaxis and preemptive therapy are not generally recommended, with the exception of high-risk patients.

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Section: Cytomegalovirus Infection In Nontransplanted Patientsmentioning

confidence: 99%

Cytomegalovirus infection in hematologic malignancy settings other than the allogeneic transplant

Marchesi¹,

Pimpinelli

Ensoli

et al. 2017

Hematological Oncology

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“…In particular, reports of localized CMV infections (i.e. retinitis, gastritis) as well as positive CMV antigenemia in asymptomatic patients [4–6] exist in the literature, yet disseminated CMV disease has not been described.…”

Section: Introductionmentioning

confidence: 99%

Disseminated cytomegalovirus disease after bendamustine: a case report and analysis of circulating B- and T-cell subsets

et al. 2019

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BackgroundBendamustine, used for the treatment of indolent B-cell non-Hodgkin lymphoma and chronic lymphocytic leukemia, is known to cause prolonged myelosuppression and lymphocytopenia and has been associated with the risk of developing serious and fatal infections. While reports of localized CMV infections in asymptomatic patients exist, disseminated CMV disease has not been described.Case presentationWe report the first case of disseminated CMV infection in a 75-year-old male diagnosed with lymphoplasmacytic lymphoma/Waldenström macroglobulinemia with massive bone marrow infiltration. Despite 6-cycle R-bendamustine chemotherapy resulted in a good partial response, the patient developed persistent fever and severe weight loss. Analysis of cerebrospinal fluid and peripheral blood revealed the presence of CMV-DNA, while the fundus oculi examination revealed bilateral CMV retinitis. Treatment with induction and maintenance drugs was complicated by neutropenia and deterioration of renal function with electrolyte imbalance. From an immunological standpoint, we observed a profound imbalances in phenotype and function of B- and T-cell subsets, with a high proportion of circulating total, activated CD69+ and CD80+ B-cells, a low γ/δ T-cell frequency with a high proportion of CD69- and CD38-expressing cells, and hyperactivated/exhausted CD4+ and CD8+ T-cell phenotypes unable to face CMV challenge.ConclusionsWe hereby describe a severe form of disseminated CMV disease after R-bendamustine treatment. Our observations strongly support the careful clinical monitoring of CMV reactivation/infection in oncologic patients undergoing this therapeutic regimen.

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“…The risk of infection associated with bendamustine has yet to be fully characterized. Small series and case reports have reported the occurrence of Pneumocystis jirovecii pneumonia (PCP) and cytomegalovirus (CMV) after bendamustine exposure [19][20][21][22]. Some clinical trials suggested that bendamustine plus rituximab (BR) was associated with fewer infections than cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab (R-CHOP) [12,13], but the same risk of infection as fludarabine and rituximab [14].…”

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confidence: 99%

Increased Risk of Infectious Complications in Older Patients With Indolent Non-Hodgkin Lymphoma Exposed to Bendamustine

Fung

Jacobsen

Freedman

et al. 2018

Clinical Infectious Diseases

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Severe CMV reactivation and gastritis during treatment of follicular lymphoma with bendamustine

Cited by 21 publications

References 5 publications

Cytomegalovirus infection in hematologic malignancy settings other than the allogeneic transplant

Cytomegalovirus infection in hematologic malignancy settings other than the allogeneic transplant

Disseminated cytomegalovirus disease after bendamustine: a case report and analysis of circulating B- and T-cell subsets

Increased Risk of Infectious Complications in Older Patients With Indolent Non-Hodgkin Lymphoma Exposed to Bendamustine

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