Relationship between cytomegalovirus (CMV) infection, reactivation and treatment protocols in bone marrow transplant patients

Introduction and Aim: The aim of this study was to investigate the clinical features of cytomegalovirus (CMV) infection and its effect on hematopoietic stem cell transplantation (HSCT) and effectiveness of treatment protocols. Material and Method: This study was performed in 2009-2016 at Gaziantep University Faculty of Medicine, Bone Marrow Transplantation Center, retrospectively. A total of 447 patients with 166 allogeneic, 281 autologous stem cell transplants were included in the study. CMV viremia was performed by polymerase-chain-reaction (PCR) routinely twice a week for the first 24 months, and in case of clinical suspicion. Results: CMV-PCR positivity was detected in 90 allogeneic HSCT patients (54%) and 41 autologous HSCT patients (14%). There was a statistically significant increase in the number of CMV-PCR values of 150-1000 copies/mL in the non-myeloablative (NMA) group compared to the myeloablative (MA) group (p=0.002). Acute/chronic GVHD were observed in 30 of allogeneic HSCT patients. CMV viremia was detected in 29 of these patients (56%) and not detected in 1 patient (1.3%). There was a statistically significant relationship between the development of acute / chronic GVHD and CMV viremia (p = 0.001). The first 100-day and 365-day mortality were higher in the group without CMV viremia in allogeneic HSCT patients (p = 0.022 and p = 0.024). The 5-year survival rate was 61% in the viremia group; 62% in the non-viremia group. There was no statistically significant difference between the two groups in terms of 5-year survival (p>0.05). In patients receiving valganciclovir treatment because of viremia, CMV disease did not develop and no adverse effect that required the drug to be discontinued was observed. Conclusion: GVHD was associated with CMV viremia. The 5-year survival was similar in HSCT patients with or without CMV viremia. Pre-emptive therapy in the CMV viremia with valganciclovir is safe an effective in HSCT. Key Words:Hematopoietic stem cell transplantation, CMV, GVHD, valganciclovir