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.
Highlights
Cytomegalovirus (CMV) reactivation especially in immunocompromised patients may rapidly progress to a fatal CMV disease associated with significant morbidity and mortality [1,2,3]
We investigated the incidence and impact of CMV reactivation in solid cancer patients by performing a retrospective analysis of our single center CMV database
The database was generated by evaluation of all CMVPCR analyses done during the infectiological work up of our mainly hematological and oncological patients treated between January 2007 and October 2012
Summary
Cytomegalovirus (CMV) reactivation especially in immunocompromised patients may rapidly progress to a fatal CMV disease associated with significant morbidity and mortality [1,2,3]. CMV disease was considered to be clinically relevant when fever of unknown origin persisted despite broad antibiotic +/− antimycotic treatment and CMV-PCR positivity was given In these cases, antiviral therapy was promptly started with intravenous ganciclovir 5 mg/m2 twice a day. In the remaining three patients the longitudinal CMV copy numbers after start of therapy could not be obtained due to fulminante clinical course Of these three patients one patient died because of infectious complications of CMV and attendant EBV reactivation, one died due to CMV and Aspergillus infection, and one patient died from massively progressive underlying disease most likely independent from CMV disease before getting any specific antiviral therapy. Gender Age Tumor entity TX setting Tumor therapy CMV copies/mL Assay (specimen) Kind of co-infection
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