Cytomegalovirus recurrence after autologous stem cell transplantation for multiple myeloma

Abstract

Background: Novel chemotherapeutic agents such as bortezomib and concomitant high-dose chemotherapy followed by autologous hematopoietic stem cell transplant (a-HSCT) for the treatment of multiple myeloma (MM) have increased the risk of recurrent cytomegalovirus (CMV) infection. Few studies have assessed the risk factors for CMV infection in this population. Methods: This retrospective single-centre study reviewed the incidence of, risk factors for, and treatment of CMV infection in patients with MM undergoing a-HSCT between June 2012 and May 2014. Results: Of 354 individuals who underwent a-HSCT during the study period, 242 were CMV seropositive, but 53 seropositive patients were excluded because of missing CMV viral load assessments. Of the 189 patients included in the analysis, 27 (14.3%) had a total of 28 significant CMV infections (defined by a PCR threshold >137 IU). CMV infections occurred within 3 weeks of a-HSCT. Of the patients with CMV infections, 33.3% (9/27) were symptomatic with fever. Therapy for CMV infection, however, was administered in 55.5% (15/27). Multivariate analysis identified 2 risk factors for CMV infection: baseline CMV viral load (OR 1.12, 95% CI 1.03 to 1.22; p=0.01) and receipt of a tandem a-HSCT within 6 months (HR 3.59, 95% CI 1.26 to 9.94; p=0.02). Conclusions: Further prospective studies with CMV viral load monitoring targeting patients at risk for CMV infection are needed to assess the risk, cost-effectiveness of monitoring, and benefit of pre-emptive therapy for prevention of CMV infection in such patients.