TY - JOUR
T1 - Association between CMV and invasive fungal infections after autologous stem cell transplant in lymphoproliferative malignancies: Opportunistic partnership or cause-effect relationship?
AU - Marchesi, Francesco
AU - Pimpinelli, Fulvia
AU - Di Domenico, Enea Gino
AU - Renzi, Daniela
AU - Gallo, Maria Teresa
AU - Regazzo, Giulia
AU - Rizzo, Maria Giulia
AU - Gumenyuk, Svitlana
AU - Toma, Luigi
AU - Marino, Mirella
AU - Cordone, Iole
AU - Cantonetti, Maria
AU - Liberati, Anna Marina
AU - Montanaro, Marco
AU - Ceribelli, Anna
AU - Prignano, Grazia
AU - Palombi, Francesca
AU - Romano, Atelda
AU - Papa, Elena
AU - Pisani, Francesco
AU - Spadea, Antonio
AU - Arcese, William
AU - Ensoli, Fabrizio
AU - Mengarelli, Andrea
PY - 2019
Y1 - 2019
N2 - Unlike allogeneic transplant, autologous stem cell transplantation (ASCT) represents a procedure with a low-risk of cytomegalovirus (CMV) symptomatic reactivation-infection/end-organ disease (CMV complications) and invasive fungal disease (IFD). However, novel drugs for the treatment of lymphoproliferative malignancies could cause an increase of such opportunistic infections, even after ASCT. To the best of our knowledge, there are no published data demonstrating an association between CMV and IFD in the autologous setting, while this association has been widely reported in allogeneic transplantation. We have reviewed our series of 347 ASCT in myeloma and lymphoma patients performed over a period of 14 years with the aim of investigating the descriptive and analytical epidemiology of bacterial, CMV and IFD complications, focusing on the association between CMV and IFD. Patients with myeloma have significantly fewer bacterial infections and IFD than patients with lymphoma, but a similar rate of CMV complications. Descriptive epidemiological data are consistent with the literature, indicating an overall incidence of 36 3.5% and 15.5% for bacterial infections, IFD and CMV complications, with a case mortality rate of 4 16.7% and 3.7 respectively. A strong correlation between CMV and IFD exists, with 8 cases of IFD out of a total of 12 presenting a CMV complication. At multivariate analysis, a diagnosis of lymphoma, ≥3 previous treatment lines and age ≥60 years were found to be independent risk factors for IFD. Duration of neutropenia (ANC textless 500/mm3) ≥7 days represents an independent risk factor for CMV complications, where neutropenia most likely represents a crude surrogate biomarker indicating a deeper and longer state of overall immunosuppression. From our data we conclude that (1) myeloma patients are at lower risk of bacterial infections and IFD as compared with lymphoma patients but are at equal risk of CMV complications, most likely as a consequence of a selective impact of bortezomib on Herpes Viruses infection control; (2) a significant association exists between CMV and IFD, although a possible cause-effect relationship remains to be determined; (3) IFD is a rare complication after ASCT but burdened by a mortality rate of about 17 with peak rates in older lymphoma patients who underwent more intensive therapeutic regimens.
AB - Unlike allogeneic transplant, autologous stem cell transplantation (ASCT) represents a procedure with a low-risk of cytomegalovirus (CMV) symptomatic reactivation-infection/end-organ disease (CMV complications) and invasive fungal disease (IFD). However, novel drugs for the treatment of lymphoproliferative malignancies could cause an increase of such opportunistic infections, even after ASCT. To the best of our knowledge, there are no published data demonstrating an association between CMV and IFD in the autologous setting, while this association has been widely reported in allogeneic transplantation. We have reviewed our series of 347 ASCT in myeloma and lymphoma patients performed over a period of 14 years with the aim of investigating the descriptive and analytical epidemiology of bacterial, CMV and IFD complications, focusing on the association between CMV and IFD. Patients with myeloma have significantly fewer bacterial infections and IFD than patients with lymphoma, but a similar rate of CMV complications. Descriptive epidemiological data are consistent with the literature, indicating an overall incidence of 36 3.5% and 15.5% for bacterial infections, IFD and CMV complications, with a case mortality rate of 4 16.7% and 3.7 respectively. A strong correlation between CMV and IFD exists, with 8 cases of IFD out of a total of 12 presenting a CMV complication. At multivariate analysis, a diagnosis of lymphoma, ≥3 previous treatment lines and age ≥60 years were found to be independent risk factors for IFD. Duration of neutropenia (ANC textless 500/mm3) ≥7 days represents an independent risk factor for CMV complications, where neutropenia most likely represents a crude surrogate biomarker indicating a deeper and longer state of overall immunosuppression. From our data we conclude that (1) myeloma patients are at lower risk of bacterial infections and IFD as compared with lymphoma patients but are at equal risk of CMV complications, most likely as a consequence of a selective impact of bortezomib on Herpes Viruses infection control; (2) a significant association exists between CMV and IFD, although a possible cause-effect relationship remains to be determined; (3) IFD is a rare complication after ASCT but burdened by a mortality rate of about 17 with peak rates in older lymphoma patients who underwent more intensive therapeutic regimens.
KW - Autologous stem cell transplant
KW - CMV infection
KW - Gram negative bacteria
KW - Gram positive bacteria
KW - Invasive fungal disease
KW - Lymphoma
KW - Multiple myeloma
KW - Skin commensals
U2 - 10.3390/ijms20061373
DO - 10.3390/ijms20061373
M3 - Article
VL - 20
JO - Int. J. Mol. Sci.
JF - Int. J. Mol. Sci.
SN - 1661-6596
IS - 6
ER -