title: Preemptive intravenous immunoglobulin allows safe and timely administration of antineoplastic therapies in patients with multiple myeloma and parvovirus B19 disease.
abstract: BACKGROUND
  Parvovirus B19 (B19) disease is a rare cause of anemia in cancer patients and often goes unrecognized, causing delays in anticancer therapy.
  
  
  METHODS
  A retrospective review was carried out of the records of patients with multiple myeloma who underwent melphalan-based autologous stem cell transplantation (MEL-ASCT) and developed B19 infection (January 2009-December 2011). Cases were defined by the presence of clinical and laboratory findings consistent with B19 disease in patients with repeatedly positive plasma quantitative polymerase chain reaction for parvovirus.
  
  
  RESULTS
  Six patients qualified as cases; 5 presented with trilineage cytopenias (chronic in 1) and 1 with anemia later progressing to pancytopenia. Transfusion-dependent thrombocytopenia led to testing in 5 patients. Two of these patients also had manifestations of autoimmune disease. Therapy with intravenous immunoglobulin (IVIG) resulted in clinical and hematologic response in all; however, 1 patient, whose white blood cell counts and serum hemoglobin levels improved, required splenectomy for persistent thrombocytopenia. All patients required additional IVIG for recurrent B19 disease. Although viral load at diagnosis did not correlate with the severity of cytopenia, its decrease was associated with response during 17 of 20 evaluable episodes (P = 0.02). Preemptive IVIG allowed the safe administration of chemotherapy in 3 patients, including MEL-ASCT in 1.
  
  
  CONCLUSIONS
  Parvovirus B19 can cause severe disease in myeloma patients including ASCT recipients. Thrombocytopenia - not anemia - was the leading presentation and may be associated with autoimmune conditions. Patients with unexplained cytopenias, particularly when prolonged, should undergo testing for circulating parvovirus. A reduction in viral load was associated with response to IVIG, although additional therapy was needed for recurrent disease. Most importantly, preemptive IVIG allowed for safe and timely administration of antineoplastic therapy in patients with ongoing B19 disease.
authors.affiliation: The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: L
authors.initials: L
authors.lastname: Katragadda
authors.forename: Z
authors.initials: Z
authors.lastname: Shahid
authors.forename: A
authors.initials: A
authors.lastname: Restrepo
authors.forename: J
authors.initials: J
authors.lastname: Muzaffar
authors.forename: D
authors.initials: D
authors.lastname: Alapat
authors.forename: E
authors.initials: E
authors.lastname: Anaissie
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D010198:Pancytopenia / Q000150:complications / Q000188:drug therapy / Q000821:virology; D010322:Parvoviridae Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D016732:Parvovirus B19, Human / Q000235:genetics / Q000302:isolation & purification*; D033581:Stem Cell Transplantation / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D016756:Immunoglobulins, Intravenous
keywords: intravenous immunoglobulin; pancytopenia; parvovirus B19; polymerase chain reaction; preemptive therapy; thrombocytopenia