Cytomegalovirus reactivation after autologous stem cell transplantation in multiple myeloma patients treated with novel agents

Naithani, Rahul; Tarai, Bansidhar

doi:10.1111/tid.12449

Cited by 3 publications

(2 citation statements)

References 3 publications

(4 reference statements)

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“…In fact, the reported increase of CMV infection/reactivation occurrence in lymphoma patients undergoing ASCT after treatment with Rituximab needs further confirmation . On the contrary, the evidence about the impact of Bortezomib in myeloma patients is more persuasive, and these data need to be confirmed by larger prospective studies. Nevertheless, even though CMV reactivation still represents an important complication, most cases are successfully managed with a specific antiviral treatment (often administered within outpatient clinical settings).…”

Section: Cytomegalovirus Infection In Autologous Hematopoietic Stem Cmentioning

confidence: 91%

“…However, it also favoured the occurrence of new infectious complications, particularly by opportunistic pathogens, including viral infections . Regarding CMV, several studies have been performed aimed at exploring the incidence and clinical impact of CMV infection/reactivation in patients undergoing ASCT in the era of intensive and pleiotropic immunosuppressive therapy . Table summarizes the main reports published during the last 20 years.…”

Section: Cytomegalovirus Infection In Autologous Hematopoietic Stem Cmentioning

confidence: 99%

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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 Autologous Hematopoietic Stem Cmentioning

confidence: 91%

Section: Cytomegalovirus Infection In Autologous Hematopoietic Stem Cmentioning

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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Multiple drugs

2016

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S Multiple drugs Cytomegalovirus reactivation: 2 case reportsIn a report 2 men developed cytomegalovirus (CMV) reactivation during treatment with novel drugs for multiple myelomas [routes not stated and not all dosages stated].A 39-year-old man was started on treatment with 6 cycles of bortezomib and dexamethasone, followed by lenalidomide for multiple myelomas and had therapy failure. He then received a cyclophosphamide, thalidomide, dexamethasone protocol and entered into partial remission. Subsequently, he was mobilised with cyclophosphamide, 1.5 g/m 2 and granulocyte colonystimulating factor (G-CSF) and conditioned with melphalan 200 mg/m 2 in first autologous stem cell transplantation (ASCT) in July 2012 and melphalan 140 mg/m 2 during tandem ASCT in October 2012. He developed Evans syndrome, 5 days after engraftment of first ASCT and was treated with prednisolone 1 mg/kg/day. On day +53 of tandem ASCT, he presented with fever, diarrhoea, and weakness. In view of persistent diarrhea and fever, a CMV polymerase chain reaction (PCR) from peripheral blood was performed and showed 9250 copies/mL. He was treated with valganciclovir. Both diarrhoea and fever responded in 4 days. A repeat CMV PCR after 1 week was negative. He was treated for 2 weeks, followed by 1 week of maintenance dose.A 55-year-old man with relapsed multiple myeloma was started on treatment with bortezomib, cyclophosphamide and dexamethasone, in complete remission was mobilised with G-CSF. He underwent ASCT with melphalan 200 mg/m2 conditioning. He engrafted on day +11 and had a second spike of fever on day +13, which lasted for about 4 days. On day 15, he developed new-onset diarrhoea and complained of dizziness. The CMV PCR from peripheral blood showed 6200 copies/mL. He was started on intravenous ganciclovir and his symptoms subsided in 5 days. A repeat CMV DNA load PCR after 1 week was negative. He was followed up with ganciclovir for 2 more weeks.Author comment: "Patients treated with bortezomibbased regimens are at higher risk of developing symptomatic CMV reactivation after ASCT."

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Cytomegalovirus reactivation in lymphoma and myeloma patients undergoing autologous peripheral blood stem cell transplantation

Massoud

Assi

Fares

et al. 2017

Journal of Clinical Virology

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Cytomegalovirus reactivation after autologous stem cell transplantation in multiple myeloma patients treated with novel agents

Cited by 3 publications

References 3 publications

Cytomegalovirus infection in hematologic malignancy settings other than the allogeneic transplant

Cytomegalovirus infection in hematologic malignancy settings other than the allogeneic transplant

Multiple drugs

Cytomegalovirus reactivation in lymphoma and myeloma patients undergoing autologous peripheral blood stem cell transplantation

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