Cytomegalovirus pneumonia in patients with lymphoma

Chemaly, Roy F.; Torres, Harrys A.; Hachem, Ray; Nogueras, Graciela M.; Aguilera, Elizabeth; Younes, Anas; Luna, Mario A.; Rodriguez, Gilhen; Tarrand, Jeffrey J.; Raad, Issam

doi:10.1002/cncr.21294

Cited by 48 publications

(50 citation statements)

References 27 publications

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“…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%.…”

Section: Other Viral Infectionsmentioning

confidence: 99%

Risk of Infections in Adult Patients with Haematological Malignancies

Nørgaard¹

2012

TOIDJ

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Abstract:Patients with haematological malignancies are at increased risk of infections not only because of the malignancy itself but also because of neutropenia induced by intensive chemotherapeutic treatment, and the cytotoxic effect on the cells that line the alimentary tract. In haematological malignancy patients with a compromised inflammatory response, the classic signs and symptoms of infection may be masked. The results of blood cultures therefore play an important diagnostic role. Bacteraemia is a relatively common serious complication occurring in around 15% of patients with haematological malignancies within the first years after diagnosis but the risk varies between different types of haematological malignancies. Other risk factors for bacteraemia are presence of mucositis, neutropenia, and use of central venous catheters. Invasive fungal diseases are also serious infectious complications in this population. Viral infections are particularty often in patients that have received a bone marrow transplant. Future work in this field could focus on potential modifiable risk factors and on how time since haematological diagnosis may influence risk of infection.

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Section: Other Viral Infectionsmentioning

confidence: 99%

Risk of Infections in Adult Patients with Haematological Malignancies

Nørgaard¹

2012

TOIDJ

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“…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%.…”

Section: Cytomegalovirusmentioning

confidence: 99%

Viral Infections in Patients with Hematological Malignancies

Wade¹

2006

Hematology

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Viral infections are important causes of morbidity and mortality for patients with a hematological malignancy. However, the true incidence and consequences of viral infections for these patients who undergo conventional nontransplant therapy are poorly defined. The difference in incidence and outcome of viral infections among patient groups is wide, but dependent upon the intensity and duration of T-cellmediated immune suppression. Infections caused by cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), respiratory syncytial virus (RSV), parainfluenza viruses and influenza viruses have been intensely studied, yet newly recognized aspects of these viral infections including late CMV infection; the emergence of new viral pathogens (human herpesvirus-6, BK virus, adenovirus, and human metapneumovirus); the development of molecular diagnostic techniques, and the potential of new agents for viral prophylaxis (maribavir), or preemptive therapy (valganciclovir) form the basis of this review. Well-designed prospective studies are needed to better clarify the spectrum of these viral infections and develop effective prevention and treatment strategies. Yet the increased use of agents like alemtuzumab that induce profound T-cell depletion demands that we develop a better understanding of viral infections that occur in patients with hematological malignancy who receive nontransplant therapy.

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“…In this population, CMV antigenemia has been reported only in small series or case studies (7)(8)(9). Even among SCT and organ transplant recipients, largescale epidemiologic studies performed to determine the effects of underlying diseases (and associated treatment), sex, age, and ethnicity on antigenemia are scanty.…”

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confidence: 99%

Epidemiologic Analysis of Reactivated Cytomegalovirus Antigenemia in Patients with Cancer

Han

2007

J Clin Microbiol

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The epidemiologic features of reactivated cytomegalovirus (CMV) antigenemia were studied among 4,382 cancer patients who were cared for and tested at the University of Texas M. D. Anderson Cancer Center from 2001 to 2004. The effects of stem cell transplant (SCT) status, underlying disease, age, sex, ethnicity, and antibody status (prior to CMV exposure) on the incidence of CMV antigenemia were determined; and the CMV burdens were quantified. Antigenemia occurred in 9.3% of patients with non-SCT (n ‫؍‬ 2511), 12.0% with autologous SCT (n ‫؍‬ 582), and 39.1% with allogeneic SCT (n ‫؍‬ 1289). Non-SCT patients with lymphoid tumors had a significantly higher rate of antigenemia than those with myeloid tumors (13.6% versus 3.9%) (P < 0.001); however, after allogeneic SCT, the underlying diseases had little effect, except for multiple myeloma (56.8%) (P ‫؍‬ 0.014). Among the allogeneic SCT recipients, higher CMV antigenemia rates were also associated with female sex, older age, and positivity for pre-SCT CMV antibody. Depending on the underlying disease and its associated initial CMV risk, allogeneic SCT increased the risk by 2.6-to 29.6-fold (overall, 4.0-fold). With or without SCT, Asians had the highest CMV antigenemia rates and burdens, followed by blacks, Hispanics, and whites, and these partially correlated with antibody prevalence. Among the 808 patients with antigenemia, the circulating peak CMV burden was significantly higher among non-SCT patients (geometric mean, 18.7 positive cells per 10 6 leukocytes) than among allogeneic SCT patients (geometric mean, 7.7 positive cells per 10 6 leukocytes) or autologous SCT patients (geometric mean, 7.0 positive cells per 10 6 leukocytes) who underwent monitoring for CMV. Together, these results allow stratification of CMV risks and suggest a substantial CMV reactivation among non-SCT cancer patients and, thus, the need for better diagnosis and control.Human cytomegalovirus (CMV), a ␤-herpesvirus, causes a variety of infections, such as congenital infections in neonates, infectious mononucleosis in healthy individuals, and reactivation in immunocompromised patients (18). CMV reactivation is a common and severe problem in organ and stem cell transplant (SCT) recipients and in those infected with human immunodeficiency virus (HIV), particularly before the era of effective antiretroviral therapy. Among SCT recipients, the rate of CMV reactivation in the bloodstream (antigenemia or viremia) has been reported to be from 30% to 70% (2, 11, 13). Routine monitoring of CMV antigenemia by testing for the CMV pp65 antigen (or other means) has played a crucial role in detecting the virus and guiding effective antiviral therapy in SCT recipients (4, 16).The incidence of CMV antigenemia among patients who have severe underlying diseases, such as leukemia, lymphoma, or solid tumors, but who are not transplant recipients or HIV infected is largely unknown. In this population, CMV antigenemia has been reported only in small series or case studies (7-9). Even among SCT and organ transpla...

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Cytomegalovirus pneumonia in patients with lymphoma

Abstract: The incidence of CMVp in patients with lymphoma is increasing. CMV detection in BAL specimens was better with culture methods than with cytologic or immunohistochemical methods. High APACHE II score and development of antiviral toxicity were associated with a fatal outcome.

Cited by 48 publications

References 27 publications

Risk of Infections in Adult Patients with Haematological Malignancies

Risk of Infections in Adult Patients with Haematological Malignancies

Viral Infections in Patients with Hematological Malignancies

Epidemiologic Analysis of Reactivated Cytomegalovirus Antigenemia in Patients with Cancer

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