Incidence of cytomegalovirus infection and disease in patients with lymphoproliferative disorders treated with alemtuzumab

Abstract

The aim of this study was to assess the incidence of cytomegalovirus (CMV) infection and disease in patients with hematologic malignancies treated with alemtuzumab. The outcome of CMV infection in hematologic patients treated with alemtuzumab in 19 hospitals throughout Spain was assessed retrospectively. Data were collected from the medical records of patients over a period of 6 months following initiation of alemtuzumab therapy. We studied 102 patients (89 with B-cell chronic lymphocytic leukemia and 13 with other lymphoproliferative diseases, with a median age of 63 years [range 29-81 years]). Alemtuzumab was administered for a mean of 11.2 (standard deviation: 13.8) weeks, with a median total dose of 423 mg (range: 59-1440 mg). Alemtuzumab as a single agent was administered in 92.2% of patients and was associated with chemotherapy in 7.8% of cases. Prophylactic antivirals included famcyclovir (47%), acyclovir (34%), valacyclovir (14%) and valgancyclovir (5%). CMV viremia testing was performed a mean of 6.3 times (range: 1-19). The incidence of CMV infection was 38.9% (46% in patients treated with steroids and 75% in patients receiving ≥1000 mg of alemtuzumab). Treatment of CMV infection included gancyclovir or valgancyclovir in 94% of cases. Viremia became negative after a median of 20 days (95% CI: 13.4-26.6). CMV disease occurred in five patients. The incidence of CMV infection in alemtuzumab-treated patients was 38.9%. The incidence increased in patients treated concomitantly with steroids and in those treated with high doses of alemtuzumab, although only eight patients received 1000 mg or more, systematic monitoring of CMV viremia and early treatment of infection resulted in a favorable outcome of CMV reactivation.

Immunosuppressive monoclonal antibodies: current and next generation

“…At 1-year follow up, the alemtuzumab arm showed slightly improved BPAR rates (20% alemtuzumab vs. 32% control) and graft survival (96% vs. 90%), but the incidence of HCMV infections was also higher. The trend for a higher rate of HCMV infection is similar to what has been observed in haematological patients receiving alemtuzumab for chronic lymphocytic leukaemia or in the setting of conditioning before allogeneic haematopoietic stem cell transplantation [41]: it has also been shown that systematic monitoring of HCMV viraemia and early treatment of infection results in a favourable outcome regarding HCMV reactivation.…”

Measuring T-cell responses against LCV and CMV in cynomolgus macaques using ELISPOT: Potential application to non-clinical testing of immunomodulatory therapeutics

“…In the case of EBV, patients receiving immunosuppression can develop post-transplant lymphoproliferative disease (PTLD) or lymphoma because the loss of immune control allows for viral transformation and outgrowth of latently infected B-cells (Gottschalk et al, 2005;Haque et al, 2002;Smets & Sokal, 2002). CMV also commonly causes disease in transplant patients that can affect multiple organs and include colitis, pneumonitis, hepatitis, and retinitis (Fishman, 2007;Kotton, 2010;Mori & Kato, 2010;Nashan et al, 2012;Sagedal et al, 2004;Steininger, 2007;Vallejo et al, 2011). Both viruses can cause disease in other patient populations with immunosuppression, such as those with HIV/AIDS (Steininger, 2007;van Baarle et al, 2001) or those receiving immunosuppressive therapies for autoimmune conditions like lupus, rheumatoid arthritis, Crohn's disease, and psoriasis (Afif & Loftus, 2009;Gentile & Foa, 2011;Woodrick & Ruderman, 2011).…”

Cytomegalovirus IgG and IgM antibodies among Sudanese patients with acute myeloid leukemia: relation to hematological prognostic markers

“…High incidence of CMV in AML was found by Capria and his colloquies and AML patients with CMV infection who were not receive antiviral treatment were reported to have more hospital admissions than those who received treatment and those with higher CMV viremea had more clinical complications [6]. Early treatment of CMV infection in patients with hematologic malignancies resulted in a favorable outcome of CMV reactivation [7]. Our results also observed that AML patients with CMV infection have poor prognosis than those without CMV infection by the evidence of hematological prognosis markers considering total white cell count and blast count.…”