Cytomegalovirus viremia, viruria and disease after autologous peripheral blood stem cell transplantation: no need for surveillance

Summary:The purpose of this study was to evaluate feasibility and efficacy of Rituximab included into a sequential salvage protocol for CD20 + B-NHL in relapse or induction failure. Twenty-seven patients with CD20 + B-NHL in relapse or induction failure received Rituximab combined with DexaBEAM (R-DexaBEAM) for stem cell mobilization. Additional ex vivo selection of CD34-positive cells was performed using the CliniMacs device. Two doses of Rituximab were included in the high-dose therapy regimen (HDT). R-DexaBEAM was well toler-

Section: Discussionmentioning

confidence: 99%

Rituximab in vivo purging is safe and effective in combination with CD34-positive selected autologous stem cell transplantation for salvage therapy in B-NHL

Flohr

Heß

Kolbe

et al. 2002

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] In our population of patients, the overall incidence of CMV pneumonia was relatively low (2%). This is a minimal estimate of the frequency as autologous BMT recipients transplanted in tertiary care referral centers frequently return to their home towns to be cared for by their primary physicians during the later post-transplant period.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] The majority of patients in this study were treated at an early stage of pneumonia. This may in part have contributed to the lower mortality rate compared to previous studies, which did not specify the proportion of patients who were treated before the development of respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

“…However, the frequency of serious CMV disease has been reported to be considerably lower, generally ranging from 1% to 9%. [1][2][3][4][5][6][7][8][9][10][11][12][13] To evaluate the frequency, timing, risk factors and response to therapy of CMV pneumonia among adult autologous BMT recipients during the first year post transplant, we reviewed the experience of 795 patients cared for at The University of Texas MD Anderson Cancer Center (MDACC).…”

mentioning

confidence: 99%

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Cytomegalovirus pneumonia in adult autologous blood and marrow transplant recipients

Konoplev

Champlin

Giralt

et al. 2001

Summary:CMV pneumonia is a major cause of morbidity and mortality among allogeneic BMT recipients. To assess the frequency, timing, risk factors and response to therapy of CMV pneumonia among autologous BMT recipients, we reviewed our experience with 795 patients. Sixteen (2%) patients were diagnosed with CMV pneumonia. The frequency was higher among patients who were seropositive than those who were seronegative (3.3% vs 0%, P = 0.008). Among seropositive patients, the frequency was higher among patients with hematological malignancies than patients with solid tumors (5.0 % vs 1.0%, P = 0.019). Eleven cases occurred Ͻ30 days, and five cases occurred Ͼ100 days post transplant. The overall CMV pneumonia-related mortality rate was 31%. Seven (78%) of nine patients treated with ganciclovir and IVIG prior to respiratory failure survived; neither of two patients treated after respiratory failure survived. Four of five (80%) untreated patients survived. In conclusion, CMV is a not infrequent cause of pneumonia among autologous BMT recipients. Risk factors include CMV seropositivity and an underlying hematological malignancy. A favorable response hinges on the prompt initiation of therapy. The survival of 25% of the patients without antiviral therapy suggests that the isolation of CMV from a BAL specimen occasionally reflects oropharyngeal contamination or that CMV pneumonia may sometimes be self-limited in more immunocompetent autologous BMT recipients. Bone Marrow Transplantation (2001) 27, 877-881.

“…5 Autograft recipients appear at lower risk of CMV disease, and post-autograft routine surveillance for CMV may not be justified. 6 Much work has been done on preventing CMV disease. In CMV seronegative recipients of a CMV seronegative graft, the incidence of CMV disease is minimal if CMVnegative blood products are used.…”

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confidence: 99%

High frequency of positive surveillance for cytomegalovirus (CMV) by PCR in allograft recipients at low risk of CMV

Butt

Clark

2001

Summary:Cytomegalovirus (CMV) causes significant morbidity and mortality following allogeneic haemopoietic stem cell transplantation. A pre-emptive strategy for ganciclovir therapy is widely used, whereby treatment is commenced on finding positive evidence of CMV replication. Surveillance by PCR has increased the sensitivity for CMV detection, but it is not known whether this may detect cases with evidence of CMV DNAemia who have a low probability of CMV disease. We reviewed our experience of CMV infection and disease since introducing CMV surveillance by PCR. All 30 allografts received bedside leucodepleted CMV-negative blood products. Seven of 10 CMV-positive recipients of a CMV-positive graft developed CMV DNAemia, with three developing clinical disease requiring ganciclovir treatment. In contrast, of 11 low risk patients (CMVnegative recipients of CMV-negative grafts), six developed evidence of CMV DNAemia although only one had clinical evidence of CMV disease requiring ganciclovir. Transfusion records confirmed that four of these had received exclusively CMV-negative blood products. The aetiology of the CMV DNAemia in these cases is unclear. It is suggested that before commencing ganciclovir therapy, confirmatory CMV antigenaemia testing is carried out on samples which test positive for CMV DNA, unless there is high clinical suspicion of CMV disease. Bone Marrow Transplantation (2001) 27, 615-619.