Risk Factors of Cytomegalovirus Infection in Autologous Stem Cell Transplantation (ASCT).

Aim: to analyse the incidence and risk factors of cytomegalovirus (CMV) infection after ASTC.

Methods: 129 pts who underwent ASCT in our Institution from June 1997 to June 2004 were analysed retrospectively ( 40 NHL, 66 MM, 8 HD, 8AML, 7CLL). Conditioning regimen consisted in MitoMel in NHL, Melphalan in MM (100–200/m²) and BEAM in AML and CLL. All patients were monitored with Ag pp65 twice weekly from conditioning therapy to hematological recovery. CMV prophylaxis consisted of acyclovir (400 mg p.o. twice daily) and the use of leucocyte-depleted blood products. Following the report of a positive CMV Ag all patients were treated with ganciclovir 5 mg/kg or foscarnet 90 mg/kg twice daily for 2 weeks or until the test was negative.

Results: we observed 8 CMV Ag positive: 5 were MM in RP at the transplant and 2 out of 3 NHL were heavily pretreated. Six patients were older than 60 years. The number of CD34 infused was 3.8x10⁶/kg (range 3.1–5.1 ). The mean time for PMN > 500/ul and platelets > 30.000/ul was respectively 11 and 21 days. CMV Ag occurred after a mean time of 21 days (4–45) following ASCT. All patients with a positive CMV Ag were febrile. CMV infection was considered the sole cause of fever in 4 pts; 2 had antibiotic-resistant fever, 1 acute enteritis and 1 pneumonia. The remaining 4 pts had concomitant sepsis: Klebsiella, Pseudomonas, Streptococcus Pneumoniae and Staphylococcus Epidermidis. Seven pts had CMV Ag levels >5/200000 cells and one pt >2/200000 at presentation. The resolution of fever and clearance of CMV Ag occurred after 5.6 days (3–9) from the start of antiviral treatment, but in 2 pts was delayed (respectively 14 and 18 days). Of note, these two pts had the highest CMV Ag levels observed (350 and 961) and one treated with foscarnet developed acute renal failure.

Conclusion:

1. 1) CMV infection is an infrequent complication of ASCT( 6,2%)

2. 2) CMV Ag detection was unrelated to the number of CD34 infused and the duration of neutropenia.

3. 3) Pts heavly pretreated, febrile or with sepsis had high rates of CMV reactivation and disease. This subset of pts require more frequent diagnostic evaluation and prompt antiviral therapy.