Incidence, Natural History and Management of Cytomegalovirus (CMV) Dnaemia and Disease in Patients with Haematological Malignancies in the Non-Allogeneic Transplantation Setting.

There is little information regarding CMV reactivation in the non-allogeneic transplantation setting. We report the incidence of CMV-DNAemia and CMV-associated disease in a cohort of patients treated for haematological malignancies at the Peter MacCallum Cancer Center from 6/99-6/04. Among the 36 patients identified, potential predictive factors were analysed, including underlying malignancy, previous therapy and therapy immediately preceding CMV-DNAemia/disease. Patients received a median of 2 prior therapies (range 1–9), age ranged from 35–77 years, with 19 males. Diseases were: acute leukaemia(6), CLL(6), NHL(21), HD(1), myeloma(2). Therapies immediately preceding CMV-DNAemia/disease were: “conventional chemotherapy” (39%, including HyperCVAD-14%), fludarabine-based (19%), autologous BMT (22%), and antibody therapy (20%, including denileukin diftitox, 6%, alemtuzumab, 14%). Risk of CMV-DNAemia/disease was calculated from the total number of patients treated over the period of analysis: alemtuzumab, (6/12; 50%), denileukin (2/33; 6%), autologous BMT (9/223; 4%), fludarabine-based (8/177; 4.5%), HyperCVAD (5/77; 6.5%). 94% were symptomatic on investigation (fever 92%, CXR changes 25%, abnormal LFT’s 3%, GI symptoms 8%, rash 6%). 7 had CMV-disease (3 pneumonitis, 2 oesophagitis, 2 enteritis/colitis). 11 had isolated fever. 14/19 treated with ganciclovir had possible/proven CMV-related illness; in 12, fever, CMV-DNAemia or symptoms resolved. 2 died from underlying disease or treatment complications. 3 asymptomatic patients with CMV-DNAemia on >1 occasion were observed until DNA negativity. 17/19 with CMV-DNAemia on only 1 occasion did not develop CMV-related illness. We recommend that patients receiving alemtuzumab, should have CMV surveillance to facilitate early therapy, though the role of ongoing surveillance/prophylaxis is unknown. Patients with persistent/rising CMV-DNA titres or evidence of CMV-disease, should be treated.