title: Cytomegalovirus infection in autologous stem cell transplant recipients in the era of rituximab.
abstract: The incidence of cytomegalovirus (CMV) reactivation/disease after autologous stem cell transplant (ASCT) is much lower than that after allogeneic stem cell transplantation. With the recent use of rituximab during cancer chemotherapy or conditioning regimens prior to transplantation, there has been an increasing concern of opportunistic infections including CMV. In the present study, we reviewed the patients undergoing ASCT from December 2007 to December 2013 to identify those developing CMV reactivation/disease. Out of the 978 patients who underwent ASCT at the Karmanos Cancer Institute, 239 patients were tested for symptomatic CMV reactivation based on clinical suspicion. Of the tested patients, 7/239 (2.9 %) were documented to have CMV reactivation within 90 days of ASCT. The median time to develop CMV viremia was 32 days from transplantation. Of the 239 patients tested, CMV viremia was detected in 3 out of 72 patients who received rituximab as compared to 4 out of 167 patients who did not. Three of these seven viremic patients were treated with anti-viral drugs; viremia resolved in all patients at a median of 24 days. Three patients were found to develop other bacterial and/or fungal infections following CMV viremia. Two of the seven patients died during 1-year follow-up, due to primary disease progression or Candida sepsis. None of the patients developed proven tissue-invasive CMV disease. The study did not evaluate the incidence of asymptomatic CMV infection/reactivation. Despite prior publications based on limited data, rituximab does not appear to contribute to an increased frequency of symptomatic CMV reactivation following ASCT.
authors.affiliation: Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA. jain.tania@mayo.edu.|, 5777 E Mayo Boulevard, Phoenix, AZ, USA. jain.tania@mayo.edu.
authors.forename: Tania
authors.initials: T
authors.lastname: Jain
authors.affiliation: Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA.
authors.forename: Jisha
authors.initials: J
authors.lastname: John
authors.affiliation: Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA.
authors.forename: Aditya
authors.initials: A
authors.lastname: Kotecha
authors.affiliation: Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Deol
authors.affiliation: Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA.
authors.forename: Tanaz
authors.initials: T
authors.lastname: Saliminia
authors.affiliation: Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA.|Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Revankar
authors.affiliation: Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA.|Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA.
authors.forename: Pranatharthi
authors.initials: P
authors.lastname: Chandrasekar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000821:virology; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification / Q000628:therapy*; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D000069283:Rituximab / Q000008:administration & dosage; D033581:Stem Cell Transplantation / Q000379:methods*; D014182:Transplantation, Autologous; D014766:Viremia / Q000175:diagnosis / Q000821:virology; D014775:Virus Activation; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D000069283:Rituximab
keywords: Autologous stem cell transplant; Cytomegalovirus infection; Rituximab