Cytomegalovirus Pneumonia in Adults with Leukemia: An Emerging Problem

Abstract

Cytomegalovirus (CMV) pneumonia is reportedly unusual among adults with leukemia who have not undergone transplantation. To assess the frequency of CMV pneumonia and its outcome during the present time, we reviewed the experience of 2136 hospitalized adults with leukemia. Sixty-one patients (2.9%) had CMV pneumonia diagnosed. The frequency doubled from 1.4% in 1992--1994 to 2.8% in 1995--1997 (P<.05). Fifty-four patients (89%) had received treatment with an immunosuppressive chemotherapeutic regimen that contained fludarabine (n=37), high-dose cytoxan (n=17), or both (n=10), and 15 patients (25%) had received granulocyte transfusions that were stimulated with hematopoietic growth factors from unscreened donors. The overall CMV pneumonia--associated mortality rate was 57%. Among autopsied patients who had leukemia, the frequency of CMV pneumonia increased from 0%, 2.3%, and 0% in 1992, 1993, and 1994, respectively, to 4.6%, 6.5%, and 16% in 1995, 1996, and 1997, respectively (P<.05). CMV has emerged as an important cause of life-threatening pneumonia in adults with leukemia who have received potent immunosuppressive therapies and stimulated granulocyte transfusions from unscreened donors.

Viral Infections in Patients with Hematological Malignancies

“…Investigators at the MD Anderson Cancer Center have reported a series of retrospective studies on the incidence of CMV disease among patients receiving conventional therapy. [20][21][22] These investigators reported an overall increase in CMV gastrointestinal disease during the past two decades, and CMV pneumonia was also increased among patients with lymphoma and acute leukemia. CMV-attributable mortality for these patients ranged from 30% to 57%.…”

Risk of Infections in Adult Patients with Haematological Malignancies

“…The incidence of CMV infection and disease is less clearly defined for patients with haematological malignancies who receive conventional therapy. Investigators at the MD Anderson Cancer Center have reported an overall increase in CMV gastrointestinal disease [57], and CMV pneumonia among patients with lymphoma [58] and acute leukemia [59]. In the absence of effective antiviral prophylaxis, the incidence of CMV infection among patients with haematological malignancy ranges from 5-75%.…”

Cytomegalovirus infections in cancer patients receiving granulocyte transfusions

“…7(p539) In that report, immunosuppressive regimens containing fludarabine, steroids, cyclophosphamide, or, interestingly, granulocyte transfusions from CMV-unscreened donors were implicated. 7 Current guidelines for the use of "CMV-safe" blood products include the use of either CMV-seronegative or leukocyte-reduced cellular blood products for CMV-seronegative patients at high risk for CMV-related morbidity and mortality. As such, the use of granulocyte transfusions from CMV-positive donors (products that are obviously leukocyte-rich and, thus, more likely to transmit virus) for CMV-negative SC transplant recipients is untenable.…”