Cytomegalovirus reactivation after autologous stem cell transplantation in myeloma and lymphoma patients: A single-center study

Table 1 Patient characteristics at transplant n (%)

Median age (range)	56 (18-72)
Sex, M/F	198/129
Diagnosis
Multiple myeloma	201 (61)
B-cell non-Hodgkin's lymphoma	80 (25)
Hodgkin's lymphoma	27 (8)
T-cell non-Hodgkin's lymphoma	19 (6)
CMV IgG seropositivity1	304 (93)
HBcIgG serositivity	46 (14)
HCVAb seropositivity1	5 (1.5)
Disease status
Complete response	205 (63)
Partial response	114 (35)
Stable/progressive disease	8 (2)
Prior chemotherapy lines
1	185 (57)
2	120 (37)
≥ 3	22 (6)
Prior fludarabine treatment	5 (1.5)
Prior alemtuzumab treatment	0
Conditioning regimen
BEAM or BEAM-like	126 (39)
MEL200/MEL100	201 (61)
Median CD34+ infused cells × 106/kg (range)	5.62 (2.36-28.48)

¹Datum is missing in 2 patients. BEAM: Carmustine, Etoposide, Cytarabine, Melphalan; MEL200: Melphalan 200 mg/m²; MEL100: Melphalan 100 mg/m²; CMV: Cytomegalovirus.

Table 2 Clinical and laboratory features and outcome of cytomegalovirus reactivation episodes requiring specific antiviral treatment (36/327, 11%)

Clinical and laboratory features	No. of cases
Fever (temperature > 38 °C persistent at least 60 min)	36 (100%)
Signs of bone marrow suppression (delay of neutrophilis and/or platelet recovery or drop in neutrophilis and/or platelet count after recovery)	35 (97%)
DNAemia positivity (PCR assay)	36 (100%)
End-organ disease (according to published criteria)	4 (11%)
Interstitial pneumonia	3
Enteritis	1
Median number of CMV copies at first detection (range)1	895 (188-10120)
Median day from transplant at first detection (range)	33 (12-77)
Pre-transplant CMV IgG seropositivity	36 (100%)
Outcome
Treatment2
Ganciclovir	8
Foscarnet sodium	16
Valganciclovir	12
Immunoglobulins	4
Need of hospital admission	20 (55%)
Hematological recovery, median (range)3
Neutrophilis > 500/mcL	14 (10-25)
Platelets > 20000/mcL	20 (11-88)
Alive	33 (92%)
Dead (48, 62, 89 d from transplant)	3 (8%)

¹Limit of detection of PCR testing: 88 copies/mL;

²Foscarnet sodium dosage: 60 mg/kg twice daily for 14 d, than 60 mg/kg per day for subsequent 5 d weekly for 2 wk); Ganciclovir dosage: 5 mg/kg twice daily for 14 d, than 5 mg/kg per day for subsequent 5 d weekly for 2 wk; Valganciclovir dosage: 900 mg twice daily for 14 d, than 900 mg/d for subsequent 5 d weekly for 2 wk;

³The occurrence of a symptomatic CMV reactivation after ASCT, requiring antiviral treatment, leads to a delay in neutrophilis and platelets recovery (P = 0.003 and P = 0.001 respectively). ASCT: Autologous hematopoietic stem cell transplantation; CMV: Cytomegalovirus.

Table 3 Risk factors for the occurrence of cytomegalovirus symptomatic reactivation

Variables		Univariate analysis		Multivariate analysis
		Occurrence of symptomaticinfection or end-organ disease	P	OR (95%CI)	P
HBcIgG	Positive	16/46 (34%)	< 0.001	8.928 (1.991-33.321)	0.023
	Negative	20/281 (7%)
Diagnosis	MM	16/201 (8%)	0.095	1.841 (1.058-5.633)	0.125
	Lymphoma	20/126 (16%)
Diagnosis of T-cell NHL	Yes	6/19 (31%)	0.022	4.739 (1.511-11.112)	0.042
	No	30/308 (10%)
Median age at transplant	Years (range)	60 (35-71) vs 52 (18-72)	0.004	2.922 (1.273-6.295)	0.088

MM: Multiple myeloma; NHL: Non-Hodgkin’s lymphoma.