Cytomegalovirus reactivation and its clinical impact in patients with solid tumors

Abstract

Cytomegalovirus reactivation can be life threatening. However, little evidence on its incidence in solid cancers is available. Therefore our single center Cytomegalovirus polymerase chain reaction database with altogether 890 CMV positive blood serum samples of mainly hematological and oncological patients was retrospectively analyzed to examine the occurrence of Cytomegalovirus reactivation in patients with solid tumors, resulting in 107 patients tested positive for Cytomegalovirus reactivation. Seventeen patients with solid cancer and a positive CMV-PCR test were identified, of which eight patients had clinically relevant CMV disease and received prompt antiviral treatment. Five patients fully recovered, but despite prompt antiviral treatment three patients died. Among these three patients two had significant co-infections (in one case EBV and in the other case Aspergillus) indicating that that CMV reactivation was at least one factor contributing to sepsis. The patient with the EBV co-infection was treated in an adjuvant therapy setting for breast cancer and died due to Cytomegalovirus and Epstein-Barr virus associated pneumonia despite intensive therapy. The other two patients had progressive disease of an underlying pancreatic cancer at the time of CMV diagnosis. One patient died due to attendant uncontrollable Aspergillus pneumonia, the other patient most likely died independent from CMV disease because of massively progressive underlying disease.Cytomegalovirus reactivation and disease might be underestimated in routine clinical practice. In our retrospective analysis we show that approximately 50 % of our patients suffering from solid cancers with a positive Cytomegalovirus polymerase chain reaction also had clinically relevant Cytomegalovirus disease requiring antiviral therapy.

Human cytomegalovirus infection and coronary heart disease: a systematic review

“…HCMV can lead to developmental and metabolic disorders of VSMCs, in which changes in proliferation and metabolism are not only the basic components of AS, but also the first components of the disease. HCMV has the characteristics of a tumor DNA virus [ 116 – 118 ]. The latent virus can be activated and recur periodically under conditions such as hypertension and hyperlipidemia so as to promote the proliferation of SMCs.…”

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

“…96 In a retrospective analysis, approximately 50% of patients with solid tumours and CMV DNA positivity also had CMV disease requiring antiviral therapy. 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.…”

“…Also, 9·3% of patients with cancer (not stem cell tranplant‐related) may experience CMV reactivation . 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 .…”

Epstein–Barr virus- and cytomegalovirus-specific immune response in patients with brain cancer

“…Chronic local inflammation in response to pathogens and/or autoantigens, orchestrated by a combination of innate and adaptive immune cell activity can lead to the oncogenesis of solid tumors [ 31 ]. Such perturbation of the overall immunological equilibrium may compromise the immune system’s ability to deter productive infection by latent pathogens and associated clinical disease [ 32 , 33 ]. Therefore, well-preserved pathogen-directed immune responses reflect a certain level of immunological fitness in patients with cancer.…”