Cytomegalovirus Reactivation Following Autologous Peripheral Blood Stem Cell Transplantation for Multiple Myeloma in the Era of Novel Chemotherapeutics and Tandem Transplantation

Abstract

Cytomegalovirus (CMV) is an important pathogen after allogeneic transplantation. However, few studies have examined CMV reactivation after autologous peripheral blood stem cell transplantation (APBSCT) to treat multiple myeloma (MM), especially in the setting of the newer chemotherapeutic agents and/or 2 sequential APBSCTs (ie, tandem transplantation). A retrospective chart review of patients with MM who underwent either single APBSCTor tandem transplantation was conducted to evaluate the incidence, risk factors, and outcomes of CMV infection at a single institution. A total of 104 patients with MM underwent transplantation during the study period, including 66 patients who received tandem transplantation. The majority of patients (66 of 104; 63.5%) were CMV-seropositive, and CMV viremia was frequently detected in this subgroup (32 of 66; 48.5%). No primary CMV infections were identified. CMV reactivation was more common in recipients of tandem transplantation than in recipients of single APBSCT (P \.001). In addition, patients who developed CMV viremia were more likely to have received conditioning therapy with melphalan, bortezomib, dexamethasone, and thalidomide compared with those without CMV reactivation (P 5 .015). However, on multiple logistic regression analysis, only receipt of tandem transplantation was significantly associated with CMV reactivation (odds ratio, 5.112; 95% confidence interval, 1.27-20.60; P 5 .022). Febrile episodes of CMV viremia were observed in 17 patients (17 of 32; 53.1%), and invasive CMV disease was diagnosed in 1 patient. Our data suggest that CMV reactivation after APBSCT for MM is relatively common, and that viremia is often associated with fever. CMV surveillance should be considered, especially when tandem transplantation is performed using combination chemotherapy with high-dose melphalan.

Cytomegalovirus infection in autologous stem cell transplant recipients in the era of rituximab

“…Previously, there have been single center studies in patients undergoing tandem transplants for multiple myeloma. Kim et al identified CMV reactivation more common in recipients of tandem transplant as compared to single transplants [15]. However, Marchesi et al did not show increased risk of CMV reactivation with tandem ASCT [16].…”

Cytomegalovirus reactivation after autologous stem cell transplantation in myeloma and lymphoma patients: A single-center study

“…However, the recent large use of immunotherapeutic drugs for the treatment of lymphomas and the introduction of proteasome inhibitors in the treatment of myeloma has determined an increase of viral infections also outside allogeneic transplantation setting, as for ASCT. In the last years, some studies have been published by our and others groups in order to better characterize the incidence of and the risk factors for CMV infection in ASCT of both in lymphoma and myeloma patients [13][14][15][16][17] . However, considering the low number of patients studied and to the multicenter nature of some previous studies (potential bias for the period were excluded from this analysis.…”

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

“…Our numbers are small, but still give an incidence of 4.3% (1/23) for single and 25% (1/4) for tandem ASCT. This high rate of CMV reactivation after tandem ASCT has been shown earlier (3). Both our patients appeared to have CMV enteritis, which could not be proven in the first case, as he refused colonoscopy.…”