Opportunistic cytomegalovirus infection in a patient receiving temozolomide for treatment of malignant glioma

Yaman, Emel; Coşkun, Uğur; Öztürk, Bayram; Büyükberber, Süleyman; Kaya, Ali; Coşkun, Özlem; Büyükberber, Nuray; Yıldız, Ramazan; Benekli, Mustafa

doi:10.1016/j.jocn.2008.05.030

Cited by 12 publications

(22 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The incidence and risk factors of temozolomide-induced CMV reactivation, as well as its optimal management, remain unclear. Steroids also causes immunosuppression and the majority of reported cases of opportunistic CMV infection occurred when patients were treated concurrently with temozolomide and steroids [4,[6][7][8][9], including our case. Therefore, treatment with temozolomide in combination with steroids is supposed to be the cause of immunosuppression and subsequent CMV reactivation.…”

Section: Discussionmentioning

confidence: 74%

“…T-cell dysfunction, treatment with temozolomide is possibly associated with a decline of the immune system and an increased susceptibility to opportunistic infections such as PCP [3,4]. This characteristic immunosuppression also induces CMV reactivation as a rare complication [4,[6][7][8][9]. The incidence and risk factors of temozolomide-induced CMV reactivation, as well as its optimal management, remain unclear.…”

Section: Discussionmentioning

confidence: 99%

“…At our institution, patients receiving more than 15 mg/day of predonisolone or those with grade 3/4 lymphocytopenia received cotrimoxazole (1 g/day) as prophylaxis for PCP. Previously, three cases of CMV pneumonia that were induced by temozolomide were reported, and lymphocytopenia occurred in all of them [6][7][8]. Two of them experienced only CMV pneumonia, and prophylaxis for PCP with cotrimoxazole had been provided for one of them [7], whereas cotrimoxazole was not mentioned for the other case [6].…”

Section: Discussionmentioning

confidence: 99%

“…Previously, three cases of CMV pneumonia that were induced by temozolomide were reported, and lymphocytopenia occurred in all of them [6][7][8]. Two of them experienced only CMV pneumonia, and prophylaxis for PCP with cotrimoxazole had been provided for one of them [7], whereas cotrimoxazole was not mentioned for the other case [6]. The third case reported by Douzinas et al [8] was not offered cotrimoxazole and developed severe PCP and coexisting CMV pneumonia.…”

Section: Discussionmentioning

confidence: 99%

“…However, severe lymphocytopenia induced by temozolomide causes opportunistic infections, such as pneumocystis pneumonia (PCP) [3,4] or fulminant hepatitis due to the reactivation of the HBV [5]. Temozolomide has also been reported to induce CMV reactivation [4,[6][7][8][9], which is due to lymphocytopenia, and to cause CMV pneumonia [6][7][8], colitis [4,7,9], and transverse myelitis [4].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Reactivation of cytomegalovirus following treatment of malignant glioma with temozolomide

Okita¹,

Narita²,

Miyakita³

et al. 2011

Int Canc Conf J

View full text Add to dashboard Cite

Temozolomide is a standard chemotherapeutic agent in the treatment of malignant gliomas. Lymphocytopenia is reported to be the most frequent and severe adverse effect, which causes opportunistic infections such as pneumocystis pneumonia (PCP) and increases the risk of the reactivation of viruses such as hepatitis B virus (HBV) and cytomegalovirus (CMV). However, the incidence of temozolomide-induced CMV reactivation remains unclear. We report on a case of a 62-year-old female with gliomatosis cerebri who had severe lymphocytopenia and pneumonia following concurrent temozolomide treatment and prophylaxis for PCP. She presented cough, fever, and severe lymphocytopenia 1 month after chemoradiotherapy with temozolomide. Her serum b-D-glucan levels remained within the normal range, which was helpful to rule out a diagnosis of PCP. Other opportunistic infections were ruled out, and a blood test for the CMV antigen was positive for pp65 antigenemia. The patient was diagnosed as having CMV pneumonia. She was treated with ganciclovir and recovered. It was very difficult to distinguish between PCP and CMV pneumonia with only the clinical presentation and radiological findings. When a patient receives temozolomide, it is important to be aware of the potential for a CMV reactivation. The serum b-D-glucan levels and pp65 antigenemia are very useful for diagnosis of CMV pneumonia.

show abstract

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Reactivation of cytomegalovirus following treatment of malignant glioma with temozolomide

Okita¹,

Narita²,

Miyakita³

et al. 2011

Int Canc Conf J

View full text Add to dashboard Cite

show abstract

Association between treatment-related lymphopenia and survival in glioblastoma patients following postoperative chemoradiotherapy

et al. 2021

View full text Add to dashboard Cite

Purpose Our study investigated the association between treatment-related lymphopenia and overall survival (OS) in a series of glioblastoma (GBM) patients. We also explored clinical and dosimetric predictors of lymphocytes depletion. Methods Between 2015 and 2019, 64 patients were treated at the same institution with postoperative chemoradiotherapy. Peripheral lymphocyte count (PLC) data and dose–volume histogram parameters were collected. Radiotherapy (RT) schedule consisted in standard total dose of 60 Gy in 30 daily fractions, with concomitant and adjuvant temozolomide (TMZ). Posttreatment acute absolute lymphopenia (nadir AAL) was calculated as a PLC lower than 1.0 × 103/mm3. Acute relative lymphopenia (ARL) was expressed by the nadir-PLC/baseline-PLC ratio < 0.5. Nadir-PLC was the lowest PLC registered between the end of RT and the first month of follow-up. Survival rates were estimated with Kaplan–Meier curves. Clinical and dosimetric variables related to AAL/ARL and OS were identified by univariate and multivariate analyses. Results A total of 57 patients were eligible and included in the analyses. The median PLC was significantly decreased following chemoradiotherapy (2180/mm3 vs 900/mm3). Median OS was 16 months (range 5–55 months), with no significant difference between patients who developed nadir AAL and those who did not (16 months vs 16.5 months; p = 0.304). When considering ARL vs non-ARL, median OS was 14 months vs 26 months (p = 0.013), respectively. In multivariate Cox regression only age, sex, extent of surgery, access to adjuvant chemotherapy and brain D98% were independently associated with OS. Conclusion Although iatrogenic immunosuppression could be associated with inferior clinical outcomes, our data show that treatment-related lymphopenia does not adversely affect GBM survival. Prospective studies are required to confirm these findings.

show abstract

Kitten-transmitted Bordetella bronchiseptica infection in a patient receiving temozolomide for glioblastoma

2010

View full text Add to dashboard Cite

Bordetella bronchiseptica is a gram negative coccobacillus that can be transmitted from domestic animals and cause severe infections in immunocompromised patients. A 56-year-old man with a left parietal glioblastoma was treated with resection, radiation and concomitant and adjuvant temozolomide chemotherapy. He received bevacizumab for progression, and dose dense metronomic temozolomide was added for additional progression. He developed chronic cough and was diagnosed with B. bronchiseptica infection. This is the first reported case of B. bronchiseptica infection in a patient receiving temozolomide. The infection was likely acquired from an infected kitten. Patients receiving temozolomide should be counseled on the risks of acquiring zoonotic infections, including B. bronchiseptica, from their pets.

show abstract

Opportunistic cytomegalovirus infection in a patient receiving temozolomide for treatment of malignant glioma

Cited by 12 publications

References 11 publications

Reactivation of cytomegalovirus following treatment of malignant glioma with temozolomide

Reactivation of cytomegalovirus following treatment of malignant glioma with temozolomide

Association between treatment-related lymphopenia and survival in glioblastoma patients following postoperative chemoradiotherapy

Kitten-transmitted Bordetella bronchiseptica infection in a patient receiving temozolomide for glioblastoma

Contact Info

Product

Resources

About