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Cytomegalovirus Reactivation Following Autologous Peripheral Blood Stem Cell Transplantation for Lymphoma and Multiple Myeloma, Single Center Experience
Methods: At our center we retrospectively reviewed the files for all adult patients with diagnosis of lymphoma or multiple myeloma (MM), who underwent autologous PBSCT between 2007-2012.
All these patients were on acyclovir or valacyclovir prophylaxis, CMV pp65 antigenemia testing was performed weekly till day 40 post transplant, and preemptive therapy was started if the antigenemia test was positive in 5 cells, or more than once positive<5 cells plus unexplained low counts, or elevated liver enzymes.
Results:
During the six years period, 210 patients underwent autologous transplant (lymphoma 55%, MM45%).97.6% of the patients were CMV IgG positive before transplant.
The rate of CMV reactivation requiring preemptive therapy as per the criteria above was 17.6%, with median time for reactivation of 31 days.
There was no difference in the rate of reactivation between lymphoma and MM, and lymphoma.
Ganciclovir was used as first line therapy in 70.3%, Valganciclovir in 24.3% and Foscarnet in 5.4%. The median duration of induction therapy was 8 days and for maintenance was 10 days.
None of our patients developed CMV disease in any organ, and the main toxicity was cytopenia with the Ganciclovir/Vaganciclovir, and renal impairment with electrolytes imbalance with Foscarnet.
At the time of the study 76% of the group were alive, with 55% were free of progression.
Conclusion:
CMV reactivation rate is low after autologous PBSCT, no need for CMV monitoring beyond 40 days, and with preemptive therapy you can eradicate CMV infection.