title: Cytomegalovirus reactivation and its clinical impact in patients with solid tumors.
abstract: Cytomegalovirus reactivation can be life threatening. However, little evidence on its incidence in solid cancers is available. Therefore our single center Cytomegalovirus polymerase chain reaction database with altogether 890 CMV positive blood serum samples of mainly hematological and oncological patients was retrospectively analyzed to examine the occurrence of Cytomegalovirus reactivation in patients with solid tumors, resulting in 107 patients tested positive for Cytomegalovirus reactivation. Seventeen patients with solid cancer and a positive CMV-PCR test were identified, of which eight patients had clinically relevant CMV disease and received prompt antiviral treatment. Five patients fully recovered, but despite prompt antiviral treatment three patients died. Among these three patients two had significant co-infections (in one case EBV and in the other case Aspergillus) indicating that that CMV reactivation was at least one factor contributing to sepsis. The patient with the EBV co-infection was treated in an adjuvant therapy setting for breast cancer and died due to Cytomegalovirus and Epstein-Barr virus associated pneumonia despite intensive therapy. The other two patients had progressive disease of an underlying pancreatic cancer at the time of CMV diagnosis. One patient died due to attendant uncontrollable Aspergillus pneumonia, the other patient most likely died independent from CMV disease because of massively progressive underlying disease. Cytomegalovirus reactivation and disease might be underestimated in routine clinical practice. In our retrospective analysis we show that approximately 50 % of our patients suffering from solid cancers with a positive Cytomegalovirus polymerase chain reaction also had clinically relevant Cytomegalovirus disease requiring antiviral therapy.
authors.affiliation: Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Laboratory of Immunological Molecular Cancer Research, Paracelsus Private Medical University Salzburg, Salzburg, Austria.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Schlick
authors.affiliation: Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Laboratory of Immunological Molecular Cancer Research, Paracelsus Private Medical University Salzburg, Salzburg, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Grundbichler
authors.affiliation: Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Laboratory of Immunological Molecular Cancer Research, Paracelsus Private Medical University Salzburg, Salzburg, Austria.
authors.forename: Jutta
authors.initials: J
authors.lastname: Auberger
authors.affiliation: Division of Medical Microbiology of the Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria.
authors.forename: Jan Marco
authors.initials: JM
authors.lastname: Kern
authors.affiliation: Department of Hospital Epidemiology and Infection Control, Paracelsus Private Medical University Salzburg, Salzburg, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Hell
authors.affiliation: Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Laboratory of Immunological Molecular Cancer Research, Paracelsus Private Medical University Salzburg, Salzburg, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Hohla
authors.affiliation: Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Laboratory of Immunological Molecular Cancer Research, Paracelsus Private Medical University Salzburg, Salzburg, Austria ; Department Onkology, Allgemeines Krankenhaus-Universitätskliniken, Wien, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Hopfinger
authors.affiliation: Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Laboratory of Immunological Molecular Cancer Research, Paracelsus Private Medical University Salzburg, Salzburg, Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Greil
keywords: CMV; Cytomegalovirus infection; EBV; Solid tumor