Contributions
Abstract: PB2054
Type: Publication Only
Background
There are abundant data on the pattern and time course of CMV reactivation or primary infection in allogeneic stem cell transplant (allo-SCT) recipients, and well-defined strategies have been developed for prophylaxis, screening and preemptive treatment.(1) However, there is a remarkable paucity of data regarding CMV reactivation in adult patients with
acute leukemia (AL) receiving chemotherapy. Re-activation can lead to prolonged cytopenias, fever and other manifestations, which are often misdiagnosed and treated empirically with antimicrobials.(2)
Aims
To investigate the prevalence of CMV DNA and its possible re-activation in adult Egyptian patients with AL receiving chemotherapy.
Methods
The study was on conducted on 63 Egyptian adult patients with newly diagnosed AL,admitted to the Hematology Unit,Internal Medicine Department, Alexandria Main University Hospital. The patients included 36 AML and 27 ALL cases. CBC, bone marrow aspiration and immunophenotyping were done at presentation. Patients were treated according to 3+7
standard protocol for AML and Larson protocol for ALL and were followed up clinically and by microbiological investigations on days 0, 14, 28 and 100 from the start of induction chemotherapy. CMV DNA was detected by real-time PCR on day 0 and day 100.
Results
AML patients included 16 males and 20 females with an age ranging from 18 to 57 years with a mean of 38.36 ± 11.98 years. ALL patients were 17 males and 10 females and included 21 B-ALL and 6 T-ALL cases. Their ages ranged from 18 to 59 years with a mean of 26.19 ± 10.24 years for B-ALL and from 19.0 to 43.0 years with a mean of 26.83 ± 9.20 years for T-ALL. 100% of enrolled patients were neutropenic and febrile on day 14. Positive blood cultures for bacteria were obtained in 72.2 % of AMLs and 76.9 % of ALLs. Invasive sino-pulmonary fungal infection was diagnosed in 25 % of AMLs, 30 % of B-ALLs and
66.7 % of T-ALL patients. By day 28, complete remission (CR) was achieved in 70.8% of AML and 80% of ALL patients, partial remission in 8.3% of AMLs and 5% of ALLs, while 20.8% of AML and 22.2% of ALL patients were refractory to induction chemotherapy. Mortality at day 28 was 33.3% and 22.2% in AML and ALL patients; respectively. None of the studied patients exhibited symptoms or signs related to CMV during the whole follow-up period. No CMV DNA was detected by real-time PCR neither on day 0 nor on day 100 among all AL patients enrolled in the study. Six out of patients in CR underwent allo-SCT from an HLA-related sibling and all of them were seropositive for CMV IgG and negative for CMV IgM throughoutand for 6 months following the transplant procedure.
Conclusion
Although CMV infection or re-activation is a serious problem in immunocompromised patients, yet it seems from ourresults that adult patients with de-novo AL do not have the same risk as neither they manifest nor CMV DNA was detected by PCR on days 0 and 100 from the initiation of standard induction chemotherapy. However,we recommend further
studies with larger samples, different chemotherapy protocols and for longer follow-up period to confirm the status of CMV infection/re-activation in adult AL patients especially among those who are candidates for allo-SCT.
Session topic: 31. Infectious diseases, supportive care
Keyword(s): acute leukemia, CMV Reactivation, PCR
Abstract: PB2054
Type: Publication Only
Background
There are abundant data on the pattern and time course of CMV reactivation or primary infection in allogeneic stem cell transplant (allo-SCT) recipients, and well-defined strategies have been developed for prophylaxis, screening and preemptive treatment.(1) However, there is a remarkable paucity of data regarding CMV reactivation in adult patients with
acute leukemia (AL) receiving chemotherapy. Re-activation can lead to prolonged cytopenias, fever and other manifestations, which are often misdiagnosed and treated empirically with antimicrobials.(2)
Aims
To investigate the prevalence of CMV DNA and its possible re-activation in adult Egyptian patients with AL receiving chemotherapy.
Methods
The study was on conducted on 63 Egyptian adult patients with newly diagnosed AL,admitted to the Hematology Unit,Internal Medicine Department, Alexandria Main University Hospital. The patients included 36 AML and 27 ALL cases. CBC, bone marrow aspiration and immunophenotyping were done at presentation. Patients were treated according to 3+7
standard protocol for AML and Larson protocol for ALL and were followed up clinically and by microbiological investigations on days 0, 14, 28 and 100 from the start of induction chemotherapy. CMV DNA was detected by real-time PCR on day 0 and day 100.
Results
AML patients included 16 males and 20 females with an age ranging from 18 to 57 years with a mean of 38.36 ± 11.98 years. ALL patients were 17 males and 10 females and included 21 B-ALL and 6 T-ALL cases. Their ages ranged from 18 to 59 years with a mean of 26.19 ± 10.24 years for B-ALL and from 19.0 to 43.0 years with a mean of 26.83 ± 9.20 years for T-ALL. 100% of enrolled patients were neutropenic and febrile on day 14. Positive blood cultures for bacteria were obtained in 72.2 % of AMLs and 76.9 % of ALLs. Invasive sino-pulmonary fungal infection was diagnosed in 25 % of AMLs, 30 % of B-ALLs and
66.7 % of T-ALL patients. By day 28, complete remission (CR) was achieved in 70.8% of AML and 80% of ALL patients, partial remission in 8.3% of AMLs and 5% of ALLs, while 20.8% of AML and 22.2% of ALL patients were refractory to induction chemotherapy. Mortality at day 28 was 33.3% and 22.2% in AML and ALL patients; respectively. None of the studied patients exhibited symptoms or signs related to CMV during the whole follow-up period. No CMV DNA was detected by real-time PCR neither on day 0 nor on day 100 among all AL patients enrolled in the study. Six out of patients in CR underwent allo-SCT from an HLA-related sibling and all of them were seropositive for CMV IgG and negative for CMV IgM throughoutand for 6 months following the transplant procedure.
Conclusion
Although CMV infection or re-activation is a serious problem in immunocompromised patients, yet it seems from ourresults that adult patients with de-novo AL do not have the same risk as neither they manifest nor CMV DNA was detected by PCR on days 0 and 100 from the initiation of standard induction chemotherapy. However,we recommend further
studies with larger samples, different chemotherapy protocols and for longer follow-up period to confirm the status of CMV infection/re-activation in adult AL patients especially among those who are candidates for allo-SCT.
Session topic: 31. Infectious diseases, supportive care
Keyword(s): acute leukemia, CMV Reactivation, PCR