Clinically significant CMV (re)activation during or after radiotherapy/chemotherapy of the brain

Goerig, Nicole L.; Semrau, Sabine; Frey, Benjamin; Korn, Klaus; Fleckenstein, Bernhard; Überla, Klaus; Dörfler, Arnd; Putz, Florian; Gaipl, Udo S.; Fietkau, Rainer

doi:10.1007/s00066-016-0987-7

Cited by 15 publications

(8 citation statements)

References 29 publications

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“…[1,15,16] Neurological decline and encephalopathy, which occur over the course of radiotherapy for brain tumors as well as for other indications, could also be attributed to CMV infection. [4,5,10]…”

Section: Discussionmentioning

confidence: 99%

“…The reactivation of CMV could also explain some deaths. [4,5] Data in the literature regarding EBV infection mostly refers to patients with nasopharyngeal cancers. Patients with advanced nasopharyngeal cancer have high plasma EBV deoxyribonucleic acid (DNA) levels at diagnosis, and monitoring EBV DNA is a sensitive and highly specific marker for detecting disease recurrence and metastasis.…”

Section: Introductionmentioning

confidence: 99%

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Human cytomegalovirus and Epstein-Barr virus infections increase the risk of death in patients with head and neck cancers receiving radiotherapy or radiochemotherapy

et al. 2018

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Viral infections, including cytomegalovirus (CMV) and Epstein-Barr virus (EBV), play an important role in carcinogenesis and can influence patients’ prognosis and condition during cancer treatment.The goal of this study was to investigate CMV and EBV infections in patients receiving radiotherapy or radiochemotherapy due to head and neck cancers to determine the influence of these infections on the risk of death. The observation period was 2 years.Of 41 patients enrolled, 11 received radiotherapy (simultaneous-integrated boost intensity-modulated radiation therapy [SIB-IMRT], 2.25 Gy/fraction, 30 fractions, [n = 7] or IMRT, 2 Gy per fraction, 35 fractions, [n = 4]) and 30 received radiochemotherapy (cisplatin 100 mg/m2 and SIB-IMRT [n = 13] or IMRT [n = 17]). Plasma CMV and EBV DNA levels were assessed using real-time PCR before or during treatment or 4 weeks posttreatment.The risk of death in the group positive for plasma CMV or EBV deoxyribonucleic acid (DNA) was significantly higher compared to the group without detectable plasma CMV (odd ratio [OR]: 7.5, 95% confidence interval [CI]: 1.11–50.67) or EBV DNA (OR: 10.91, 95% CI: 1.135–104.8). Results were confirmed using the Bayesian method. Plasma positivity for CMV or EBV DNA was associated with a higher risk of death (both P = .04).Viral infections negatively affect the survival of patients with head and neck cancers. Diagnosing and treating these viral infections in patients with positive results should be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Human cytomegalovirus and Epstein-Barr virus infections increase the risk of death in patients with head and neck cancers receiving radiotherapy or radiochemotherapy

et al. 2018

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“…Ri zi ka su sirg ti CMV en ce fa li tu ypaè ið au ga li go niams po kau lø èiul pø transp lan ta ci jos, uþ si krë tu siems ÞIV ir tiems, ku riems tai ko ma gal vos sme ge nø na vi kø ra dio te ra pi ja [22]. Pas ta rie siems li go niams CMV en ce fa li tas ga li ið sivys ty ti dar ne bai gus ra dio te ra pi jos kur so, o su CMV in fek -ci ja su si ju si en ce fa lo pa ti ja daþ nai klai din gai pri ski ria ma ða lu ti niam ra dio te ra pi jos po vei kiui [23,24]. CMV en ce fali tu ser gan tiems li go niams daþ niau siai pa si reið kia po ûmis kog ni ty vi niø ir þie vi niø funk ci jø su tri ki mas bei to kie simp to mai, kaip mie guis tu mas ir trau ku liai.…”

Section: Infekcinio Encefalito Pasireiðkimas Ir Ligos Sukëlëjø Diagnounclassified

Infekcinio encefalito diagnostika ir gydymas imunosupresinių būklių metu: klinikinio atvejo pristatymas ir literatūros apžvalga

Jokubaitis¹,

Valaikienė²

2019

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Vilniaus universiteto Medicinos fakultetas, Klinikinës medicinos instituto Neurologijos centrasÁVADAS Nau jau sios li te ra tû ros duo me ni mis, en ce fa li to daþ nis siekia iki 12,6 at ve jo 100 000 gy ven to jø per me tus, apie 50 % jø yra in fek ci nës kil mës, 20-30 % -au to imu ni niai, li kaene nu sta ty tos etio lo gi jos [1][2][3]. Pran cû zi jo je at lik to perspek ty vi nio ty ri mo duo me ni mis, daþ niau si in fek ci nio ence fa li to su kë lë jai yra Her pes sim plex vi ru sas (HSV) (42 %), Varicella zoster vi ru sas (VZV) (15 %), My co bacte rium tu ber cu lo sis (15 %) ir Lis te ria monocytogenes (10 %) [4]. Bû din gi kli ni ki niai en ce fa li to po þy miai yra karð èia vi mas, nau jai at si ra dae trau ku liai ir þi di ni në neu rolo gi në simp to ma ti ka [1]. Imu no sup re si niø (angl. immunosuppressed) li go niø cen tri nës ner vø sis te mos (CNS) in fekci jø diag nos ti ka yra su dë tin ga, nes jiems mi në ti kli ni ki niai simp to mai ir po þy miai ga li ne pa si reikð ti, o la bo ra to ri niai ir in stru men ti niai duo me nys -bû ti ne ti pi niai [5]. Ne re tai imu no sup re si niø li go niø in fek ci nio en ce fa li to su kë lë jai yra ne bû din gi imu no kom pe ten ti niams (angl. immunocompetent) as me nims, o imu no sup re si niø li go niø, ser gan èiø in fek ci niu en ce fa li tu, mir tin gu mas yra di des nis, ly gi nant su imu no kom pe ten ti niais, ne pri klau so mai nuo li gos su këlë jo [6,7]. Dvi di dþiau sios imu no sup re si niø, kar tu ir di delës in fek ci nio en ce fa li to ri zi kos, li go niø gru pës yra ser gantie ji on ko lo gi në mis li go mis ir li go niai, var to jan tys imu nosup re si nius vais tus [5].ATVEJO APRAÐYMAS 62 m. vy ras sku biai at veþ tas á ar ti miau sià in sul to cen trà dël ry te pa ste bë to kal bos su tri ki mo. Neu ro lo gi nës ap þiû ros me tu nu sta ty ta da li në sen so mo to ri në afa zi ja ir leng vo laips nio de ði nio ji he mi pa re zë. At li kus sku bià gal vos smege nø kom piu te ri nae to mog ra fi jà (GSKT), ûmiø pa ki ti mø ne nu sta ty ta. Diag no zuo tas ûmus gal vos sme ge nø in sul tas 98 NEUROLOGIJOS SEMINARAI • ISSN 1392-3064 / eISSN 2424-5917 © Neurologijos seminarai, 2019. Open Ac cess. This ar ti cle is dis trib uted un der the terms of the Cre ative Com mons At tri bu tion 4.0 Inter na tional Li cense CC-BY 4.0 (http://creativecommons.org/licenses/by/4.0/), which per mits un re stricted use, dis tri bu tion, and re produc tion in any me dium, pro vided you give ap pro pri ate credit to the orig i nal au thor(s) and the source, pro vide a link to the Cre ative Com mons li cense, and in di cate if changes were made. KLINIKINIS ATVEJISNeurologijos seminarai 2019; 23(80): 98-105 Santrauka. In fek ci nis en ce fa li tas imu no sup re si niø bûk liø me tu yra ne re tai pa si tai kan ti, grei tos diag nos ti kos ir anks ty vo gy dy mo rei ka lau jan ti bûk lë, ga lin ti sà ly go ti sun kø neu ro logi ná de fi ci tà ir net li go nio mir tá. Ði pro ble ma tam pa itin ak tu a li di dë jant ser ga mu mui on ko logi në mis ir au to ...

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“…In a retrospective analysis, approximately 50% of patients with solid tumours and CMV DNA positivity also had CMV disease requiring antiviral therapy . Reactivation in these patients during chemotherapy was not asymptomatic but was mostly self‐limiting . However, CMV viraemia predicts high mortality (61·3%) in patients with cancer requiring mechanical ventilation .…”

Section: Cmv‐specific Memory Inflation Shapes Global and Anti‐tumour mentioning

confidence: 99%

“…97 Reactivation in these patients during chemotherapy was not asymptomatic but was mostly self-limiting. 98,99 However, CMV viraemia predicts high mortality (61Á3%) in patients with cancer requiring mechanical ventilation. 100 Gastrointestinal CMV disease is associated with high morbidity and mortality, although it is uncommon in patients with solid tumours.…”

Section: Cmv-specific Memory Inflation Shapes Global and Anti-tumour mentioning

confidence: 99%

The impact of inflationary cytomegalovirus‐specific memory T cells on anti‐tumour immune responses in patients with cancer

et al. 2018

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Human cytomegalovirus (CMV) is a ubiquitous, persistent beta herpesvirus. CMV infection contributes to the accumulation of functional antigen-specific CD8 T-cell pools with an effector-memory phenotype and enrichment of these immune cells in peripheral organs. We review here this 'memory T-cell inflation' phenomenon and associated factors including age and sex. 'Collateral damage' due to CMV-directed immune reactivity may occur in later stages of life - arising from CMV-specific immune responses that were beneficial in earlier life. CMV may be considered an age-dependent immunomodulator and a double-edged sword in editing anti-tumour immune responses. Emerging evidence suggests that CMV is highly prevalent in patients with a variety of cancers, particularly glioblastoma. A better understanding of CMV-associated immune responses and its implications for immune senescence, especially in patients with cancer, may aid in the design of more clinically relevant and tailored, personalized treatment regimens. 'Memory T-cell inflation' could be applied in vaccine development strategies to enrich for immune reactivity where long-term immunological memory is needed, e.g. in long-term immune memory formation directed against transformed cells.

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Clinically significant CMV (re)activation during or after radiotherapy/chemotherapy of the brain

Abstract: Further prospective studies verifying and investigating this observation in terms of frequency and clinical relevance seem indicated.

Cited by 15 publications

References 29 publications

Human cytomegalovirus and Epstein-Barr virus infections increase the risk of death in patients with head and neck cancers receiving radiotherapy or radiochemotherapy

Human cytomegalovirus and Epstein-Barr virus infections increase the risk of death in patients with head and neck cancers receiving radiotherapy or radiochemotherapy

Infekcinio encefalito diagnostika ir gydymas imunosupresinių būklių metu: klinikinio atvejo pristatymas ir literatūros apžvalga

The impact of inflationary cytomegalovirus‐specific memory T cells on anti‐tumour immune responses in patients with cancer

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