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Investigation of the effect of chemotherapy on cytomegalovirus reactivity in patients with solid organ tumors

Year 2021, Volume: 7 Issue: 1, 38 - 43, 04.01.2021
https://doi.org/10.18621/eurj.573407

Abstract

Objectives: Chemotherapy induces an immunosuppressive state in patients with solid organ tumors. Cytomegalovirus (CMV) reactivation as a result of immunosuppression causes a severe clinical manifestation. However, in this group, CMV infections developing due to reactivation were not adequately discussed in the literature. The aims of this study were to determine the incidence of CMV reactivation after chemotherapy, to evaluate the contribution of chemotherapy to reactivation, to determine the incidence of asymptomatic and symptomatic infections and to investigate the results of the treatment.

Methods: A total of 93 patients with solid tumors were included in the study. Weekly blood samples were collected from the patients for three weeks before and after chemotherapy. Quantitative analysis of DNA was detected using CMV PCR kit (GeneProof CMV PCR kit, Bruno, Czech Republic). Diagnosis and treatment of patients were retrospectively reviewed.

Results: Of the patients, 65.6% were female and 34.4% were male. The mean age was 55 ± 12 years. The most common cancer types among the patients were breast cancer in 45.2%, lung cancer in 15.1%, and colon cancer in 12.9%. The mean leukocyte count of the patients was 7,647/mm3. CMV DNA was not detected in any patient. According to this result, none of the patients had CMV reactivation after chemotherapy. 

Conclusions: In this study including patients with solid organ tumors with mild to moderate level of immunosuppression CMV DNA was not detected in any patient. Based on this finding no standard prophylaxis was required for CMV in this group of patients.

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References

  • 8. Osawa R, Singh N. Cytomegalovirus infection in critically ill patients: a systematic review. Crit Care 2009;13:R68.
  • 9. Wang YC, Wang NC, Lin JC, Perng CL, Yeh KM, Yang YS, et al. Risk factors and outcomes of cytomegalovirus viremia in cancer patients: A study from a medical center in northern Taiwan. J Microbiol Immunol Infect 2011;44:442-8.
  • 10. Bruminhent J, Razonable RR. Management of cytomegalovirus infection and disease in liver transplant recipients.World J Hepatol 2014;6:370-83.
  • 11. Emiroglu HH, Kebudi R, Zülfikar B, Görgün Ö, Yilmaz G, Ayan I, et al. [Cytomegalovirus pneumonia in a pediatric patient with solid tumor]. Türk Onkoloji Dergisi 2009;24:85-7. [Article in Turkish]
  • 12. Linares L, Sanclemente G, Cervera C, Hoyo I, Cofán F, Ricart MJ, et al. Influence of cytomegalovirus disease in outcome of solid organ transplant patients. Transplant Proc 2011;43:2145-8.
  • 13. Wang YC, Lee HS, Lin TY, Wang NC. Cytomegalovirus colitis mimics amebic colitis in a man with AIDS. Am J Med Sci 2008;336:362-4.
  • 14. Ljungman P, Hakki M, Boeckh M. Cytomegalovirus in hematopoietic stem cell transplant recipients. Infect Dis Clin North Am 2010;24:319-7.
  • 15. Bates M, Brantsaeter AB. Human cytomegalovirus (CMV) in Africa: a neglected but important pathogen. J Virus Erad 2016;2:136-42.
  • 16. Ziemann M, Sedemund-Adib B, Reiland P, Schmucker P, Hennig H. Increased mortality in long-term intensive care patients with active cytomegalovirus infection. Crit Care Med 2008;36:3145-50.
  • 17. Heininger A, Jahn G, Engel C, Notheisen T, Unertl K, Hamprecht K. Human cytomegalovirus infections in nonimmunosuppressed critically ill patients. Crit Care Med 2001;29:541-7.
  • 18. Jaber S, Chanques G, Borry J, Souche B, Verdier R, Perrigault PF, et al. Cytomegalovirus infection in critically ill patients: associated factors and consequences. Chest 2005;127:233-41.
  • 19. Mera JR, Whimbey E, Elting L, Preti A, Luna MA, Bruner JM, et al. Cytomegalovirus pneumonia in adult nontransplantation patients with cancer: review of 20 cases occurring from 1964 through 1990. Clin Infect Dis 1996;22:1046-50.
  • 20. Capria, S, Gentile G, Capobianchi A, Cardarelli L, Gianfelici V, Trisolini, S, et al. Prospective cytomegalovirus monitoring during first-line chemotherapy in patients with acute myeloid leukemia. J Med Virol 2010;82:1201-7.
  • 1. Griffiths P, Lumley S. Cytomegalovirus. Curr Opin Infect Dis 2014;27:554-9.
  • 2. Kotton CN. CMV. Prevention, diagnosis and therapy. Am J Transplant 2013;13:24-40.
  • 21. Kuo CP, Wu CL, Ho HT, Chen CG, Liu SI, Lu YT. Detection of cytomegalovirus reactivation in cancer patients receiving chemotherapy. Clin Microbiol Infect 2008;14:221-7.
  • 22. Schlumbrecht M, Grimes K, Brown J. Cytomegalovirus reactivation following chemoradiation for invasive cervical carcinoma. Gynecol Oncol Case Rep 2011;1:22-3.
  • 23. Sandherr M, Einsele H, Hebart H, Kahl C, Kern W, Kiehl M, et al. Antiviral prophylaxis in patients with haematological malignancies and solid tumours: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Oncology (DGHO). Ann Oncol 2006;17:1051-9.
  • 3. Beam E, Razonable RR. Cytomegalovirus in solid organ transplantation: epidemiology, prevention, and treatment. Curr Infect Dis Rep 2012;14:633-41.
  • 4. Bate SL, Dollard SC, Cannon MJ. Cytomegalovirus seroprevalence in the United States: the national health and nutrition examination surveys, 1988-2004. Clin Infect Dis 2010;50:1439-47.
  • 5. Razonable RR, Emery VC. Management of CMV infection and disease in transplant patients. 27-29 February 2004. Herpes 2004;11:77-86.
  • 6. Schlick K, Grundbichler M, Auberger J, Kern JM, Hell M, Hohla F, et al. Cytomegalovirus reactivation and its clinical impact in patients with solid tumors. Infect Agent Cancer 2015;10:45.
  • 24. Hummel M, Abecassis MM. A model for reactivation of CMV from latency. J Clin Virol 2002;25:S123-36.
  • 25. Torres HA, Aguilera E, Safdar A, Rohatgi N, Raad II, Sepulveda C, et al. Fatal cytomegalovirus pneumonia in patients with haematological malignancies: an autopsy-based case-control study. Clin Microbiol Infect 2008;14:1160-6.
  • 26. Torres HA, Kontoyiannis DP, Bodey GP, Adachi JA, Luna MA, Tarrand JJ, et al. Gastrointestinal cytomegalovirus disease in patients with cancer: a two decade experience in a tertiary care cancer center. Eur J Cancer 2005;41:2268-79.
  • 7. Watkins RR, Lemonovich TL, Razonable RR. Immune response to CMV in solid organ transplant recipients: current concepts and future directions. Expert Rev Clin Immunol 2012;8:383-93.
  • 27. Hosoda T, Yokoyama A, Yoneda M, Yamamoto R, Ohashi K, Kagoo T, et al. Bendamustine can severely impair T-cell immunity against cytomegalovirus. Leuk Lymphoma 2013;54:1327-8.
  • 28. Melendez D, Razonable RR. Immune-based monitoring for cytomegalovirus infection in solid organ transplantation: is it ready for clinical primetime? Expert Rev Clin Immunol 2014;10:1213-27.
  • 29. Boeckh M, Nichols WG. The impact of cytomegalovirus serostatus of donor and recipient before hematopoietic stem cell transplantation in the era of antiviral prophylaxis and preemptive therapy. Blood 2004;103:2003-8.
  • 30. Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med 2007;357:2601-14.
Year 2021, Volume: 7 Issue: 1, 38 - 43, 04.01.2021
https://doi.org/10.18621/eurj.573407

Abstract

Project Number

No

References

  • 8. Osawa R, Singh N. Cytomegalovirus infection in critically ill patients: a systematic review. Crit Care 2009;13:R68.
  • 9. Wang YC, Wang NC, Lin JC, Perng CL, Yeh KM, Yang YS, et al. Risk factors and outcomes of cytomegalovirus viremia in cancer patients: A study from a medical center in northern Taiwan. J Microbiol Immunol Infect 2011;44:442-8.
  • 10. Bruminhent J, Razonable RR. Management of cytomegalovirus infection and disease in liver transplant recipients.World J Hepatol 2014;6:370-83.
  • 11. Emiroglu HH, Kebudi R, Zülfikar B, Görgün Ö, Yilmaz G, Ayan I, et al. [Cytomegalovirus pneumonia in a pediatric patient with solid tumor]. Türk Onkoloji Dergisi 2009;24:85-7. [Article in Turkish]
  • 12. Linares L, Sanclemente G, Cervera C, Hoyo I, Cofán F, Ricart MJ, et al. Influence of cytomegalovirus disease in outcome of solid organ transplant patients. Transplant Proc 2011;43:2145-8.
  • 13. Wang YC, Lee HS, Lin TY, Wang NC. Cytomegalovirus colitis mimics amebic colitis in a man with AIDS. Am J Med Sci 2008;336:362-4.
  • 14. Ljungman P, Hakki M, Boeckh M. Cytomegalovirus in hematopoietic stem cell transplant recipients. Infect Dis Clin North Am 2010;24:319-7.
  • 15. Bates M, Brantsaeter AB. Human cytomegalovirus (CMV) in Africa: a neglected but important pathogen. J Virus Erad 2016;2:136-42.
  • 16. Ziemann M, Sedemund-Adib B, Reiland P, Schmucker P, Hennig H. Increased mortality in long-term intensive care patients with active cytomegalovirus infection. Crit Care Med 2008;36:3145-50.
  • 17. Heininger A, Jahn G, Engel C, Notheisen T, Unertl K, Hamprecht K. Human cytomegalovirus infections in nonimmunosuppressed critically ill patients. Crit Care Med 2001;29:541-7.
  • 18. Jaber S, Chanques G, Borry J, Souche B, Verdier R, Perrigault PF, et al. Cytomegalovirus infection in critically ill patients: associated factors and consequences. Chest 2005;127:233-41.
  • 19. Mera JR, Whimbey E, Elting L, Preti A, Luna MA, Bruner JM, et al. Cytomegalovirus pneumonia in adult nontransplantation patients with cancer: review of 20 cases occurring from 1964 through 1990. Clin Infect Dis 1996;22:1046-50.
  • 20. Capria, S, Gentile G, Capobianchi A, Cardarelli L, Gianfelici V, Trisolini, S, et al. Prospective cytomegalovirus monitoring during first-line chemotherapy in patients with acute myeloid leukemia. J Med Virol 2010;82:1201-7.
  • 1. Griffiths P, Lumley S. Cytomegalovirus. Curr Opin Infect Dis 2014;27:554-9.
  • 2. Kotton CN. CMV. Prevention, diagnosis and therapy. Am J Transplant 2013;13:24-40.
  • 21. Kuo CP, Wu CL, Ho HT, Chen CG, Liu SI, Lu YT. Detection of cytomegalovirus reactivation in cancer patients receiving chemotherapy. Clin Microbiol Infect 2008;14:221-7.
  • 22. Schlumbrecht M, Grimes K, Brown J. Cytomegalovirus reactivation following chemoradiation for invasive cervical carcinoma. Gynecol Oncol Case Rep 2011;1:22-3.
  • 23. Sandherr M, Einsele H, Hebart H, Kahl C, Kern W, Kiehl M, et al. Antiviral prophylaxis in patients with haematological malignancies and solid tumours: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Oncology (DGHO). Ann Oncol 2006;17:1051-9.
  • 3. Beam E, Razonable RR. Cytomegalovirus in solid organ transplantation: epidemiology, prevention, and treatment. Curr Infect Dis Rep 2012;14:633-41.
  • 4. Bate SL, Dollard SC, Cannon MJ. Cytomegalovirus seroprevalence in the United States: the national health and nutrition examination surveys, 1988-2004. Clin Infect Dis 2010;50:1439-47.
  • 5. Razonable RR, Emery VC. Management of CMV infection and disease in transplant patients. 27-29 February 2004. Herpes 2004;11:77-86.
  • 6. Schlick K, Grundbichler M, Auberger J, Kern JM, Hell M, Hohla F, et al. Cytomegalovirus reactivation and its clinical impact in patients with solid tumors. Infect Agent Cancer 2015;10:45.
  • 24. Hummel M, Abecassis MM. A model for reactivation of CMV from latency. J Clin Virol 2002;25:S123-36.
  • 25. Torres HA, Aguilera E, Safdar A, Rohatgi N, Raad II, Sepulveda C, et al. Fatal cytomegalovirus pneumonia in patients with haematological malignancies: an autopsy-based case-control study. Clin Microbiol Infect 2008;14:1160-6.
  • 26. Torres HA, Kontoyiannis DP, Bodey GP, Adachi JA, Luna MA, Tarrand JJ, et al. Gastrointestinal cytomegalovirus disease in patients with cancer: a two decade experience in a tertiary care cancer center. Eur J Cancer 2005;41:2268-79.
  • 7. Watkins RR, Lemonovich TL, Razonable RR. Immune response to CMV in solid organ transplant recipients: current concepts and future directions. Expert Rev Clin Immunol 2012;8:383-93.
  • 27. Hosoda T, Yokoyama A, Yoneda M, Yamamoto R, Ohashi K, Kagoo T, et al. Bendamustine can severely impair T-cell immunity against cytomegalovirus. Leuk Lymphoma 2013;54:1327-8.
  • 28. Melendez D, Razonable RR. Immune-based monitoring for cytomegalovirus infection in solid organ transplantation: is it ready for clinical primetime? Expert Rev Clin Immunol 2014;10:1213-27.
  • 29. Boeckh M, Nichols WG. The impact of cytomegalovirus serostatus of donor and recipient before hematopoietic stem cell transplantation in the era of antiviral prophylaxis and preemptive therapy. Blood 2004;103:2003-8.
  • 30. Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med 2007;357:2601-14.
There are 30 citations in total.

Details

Primary Language English
Subjects Infectious Diseases
Journal Section Original Articles
Authors

Aslıhan Demirel 0000-0001-6309-1809

Kezban Nur Pilancı This is me 0000-0002-0901-819X

Neşe İnan This is me 0000-0002-1559-6244

Nur Efe İris This is me 0000-0001-6725-5188

Arzu Baygül This is me 0000-0002-4859-0009

Gökhan Demir This is me 0000-0001-6725-5188

Emine Sönmez This is me 0000-0002-5913-1019

Project Number No
Publication Date January 4, 2021
Submission Date June 10, 2019
Acceptance Date January 31, 2020
Published in Issue Year 2021 Volume: 7 Issue: 1

Cite

AMA Demirel A, Nur Pilancı K, İnan N, İris NE, Baygül A, Demir G, Sönmez E. Investigation of the effect of chemotherapy on cytomegalovirus reactivity in patients with solid organ tumors. Eur Res J. January 2021;7(1):38-43. doi:10.18621/eurj.573407

e-ISSN: 2149-3189 


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