Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Sep 24, 2015; 5(3): 129-136
Published online Sep 24, 2015. doi: 10.5500/wjt.v5.i3.129
Cytomegalovirus reactivation after autologous stem cell transplantation in myeloma and lymphoma patients: A single-center study
Francesco Marchesi, Fulvia Pimpinelli, Svitlana Gumenyuk, Daniela Renzi, Francesca Palombi, Francesco Pisani, Atelda Romano, Antonio Spadea, Elena Papa, Marco Canfora, Fabrizio Ensoli, Andrea Mengarelli
Francesco Marchesi, Svitlana Gumenyuk, Daniela Renzi, Francesca Palombi, Francesco Pisani, Atelda Romano, Antonio Spadea, Elena Papa, Andrea Mengarelli, Hematology and Stem Cell Transplantation Unit, Regina Elena National Cancer Institute, 00144 Rome, Italy
Fulvia Pimpinelli, Fabrizio Ensoli, Molecular Virology, Pathology and Microbiology Laboratory, San Gallicano Dermatological Institute, 00144 Rome, Italy
Marco Canfora, Scientific Direction, Regina Elena National Cancer Institute, 00144 Rome, Italy
Author contributions: Marchesi F and Mengarelli A contributed to the concept and design of the study; Marchesi F, Gumenyuk S, Renzi D, Palombi F, Pisani F, Romano A and Spadea A performed the clinical management and data collection; Pimpinelli F and Ensoli F performed the virological laboratory studies; Marchesi F, Papa E and Canfora M made the data analysis and interpretation; Marchesi F wrote the manuscript; Marchesi F and Mengarelli A made the final critical revision of the manuscript.
Institutional review board statement: The study was approved by the institutional Ethical Committee without a formal document, considering that all patients had signed an informed consent granting use of sensitive data for scientific purposes at time of admission in our Institute.
Informed consent statement: All the patients had signed an informed consent granting use of sensitive data for scientific purposes at time of admission in our Institute.
Conflict-of-interest statement: No disclosures.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Francesco Marchesi, MD, Hematology and Stem Cell Transplantation Unit, Regina Elena National Cancer Institute, Via E. Chianesi 53, 00144 Rome, Italy. marchesi.francesco@tiscali.it
Telephone: +39-6-52665022 Fax: +39-6-52662849
Received: May 8, 2015
Peer-review started: May 9, 2015
First decision: June 3, 2015
Revised: June 12, 2015
Accepted: July 7, 2015
Article in press: July 8, 2015
Published online: September 24, 2015
Processing time: 139 Days and 13.9 Hours
Abstract

AIM: To determine the incidence of and the risk factors for cytomegalovirus (CMV) symptomatic infection and end-organ disease after autologous stem cell transplantation (ASCT).

METHODS: A total of 327 consecutive non CD34+ selected autografts performed from the Hematology and Stem Cell Transplantation Unit of Regina Elena National Cancer Institute of Rome (Italy) in the period comprised between January 2003 to January 2015, were reviewed. Over the 327 autografts, 201 were performed in patients with multiple myeloma, whereas the remaining 126 in patients affected by non-Hodgkin’s lymphoma and Hodgkin’s lymphoma. The patients who underwent an ASCT for an acute leukemia (n = 20) in the same period were excluded from this analysis. CMV DNA load in the blood has been determined by polymerase-chain reaction in the case of a clinical suspicion of reactivation, therefore, no routine monitoring strategy was adopted. In the presence of signs and symptoms of CMV reactivation an antiviral treatment was performed.

RESULTS: Overall, 36 patients (11%) required a specific antiviral treatment for a symptomatic CMV reactivation (n = 32) or an end-organ disease (n = 4). We observed 20 and 16 cases of CMV reactivation among lymphoma (16%) and myeloma patients (8%), respectively. Among cases of end-organ disease, 3 were diagnosed as interstitial pneumonia and one remaining case as hemorrhagic enteritis. All cases of CMV reactivation were observed in IgG seropositive patients, with no documented cases of primary CMV infection. All patients were treated with a specific antiviral therapy, with a global rate of hospitalization of 55%; four patients received intravenous immunoglobulins. Transplant-related mortality was significantly higher in patients who experienced a CMV reactivation (8.4% ± 4.7% vs 1.7% ± 0.8%; P = 0.047). In univariate analysis, a pre-transplant HBcIgG seropositivity, a diagnosis of T-cell non-Hodgkin’s lymphoma and higher median age at transplant were significantly associated with the risk of developing a clinically relevant CMV infection requiring specific antiviral therapy (P < 0.001, P = 0.042 and P = 0.004, respectively). In multivariate analysis, only a pre-transplant HBcIgG seropositivity (OR = 8.928, 95%CI: 1.991-33.321; P = 0.023) and a diagnosis of T-cell non-Hodgkin’s lymphoma (OR = 4.739, 95%CI: 1.511-11.112; P = 0.042) proved to be independent predictors of a post-transplant clinically relevant CMV reactivation.

CONCLUSION: A symptomatic CMV infection can occur in about 11% of adult patients with lymphoma or myeloma undergoing ASCT. A pre-transplant HBcIgG seropositivity and a diagnosis of T-cell non-Hodgkin’s lymphoma should be considered as independent predictor factors of CMV reactivation.

Keywords: Cytomegalovirus; Autologous hematopoietic stem cell transplantation; Lymphoma; Myeloma; HBcIgG seropositivity; Transplant-related mortality

Core tip: Data about cytomegalovirus (CMV) reactivation in autologous hematopoietic stem cell transplantation (ASCT) are limited. We performed a retrospective observational study on 327 autografts consecutively performed for lymphoma (n = 126) or myeloma (n = 201) patients in our Institution. Aim of the study was to determine the incidence of and the risk factors for CMV symptomatic infection and/or end-organ disease, defined according to published recommendations, and the impact on Transplant-Related Mortality. Our data show that a symptomatic CMV infection can occur in about 11% of adult patients with lymphoma or myeloma undergoing ASCT. Most of cases of CMV reactivation are easily manageable but it can be a potentially life-threatening complication. As for risk factors, a pre-transplant HBcIgG seropositivity and a diagnosis of T-cell non-Hodgkin’s lymphoma should be considered as independent risk factors for CMV reactivation after ASCT.