Multiple drugs

Abstract

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."