Cytomegalovirus Infection in Non-transplant Patients with Hematologic Neoplasms: A Case Series

Background: Cytomegalovirus (CMV) infection is uncommon in hematology patients. Theclinical pictures and outcomes of this virus are not entirely clear.Method: Consecutive cases of CMV infection (17 patients with 20 episodes) werecompiled for study over a six year period.Results: CMV infection occurred in patients of various ages and with a number ofunderlying hematological diseases, including non-Hodgkin’s lymphoma,multiple myeloma (MM), acute myeloid leukemia (AML) and myeloproliferativeneoplasm, No single laboratory assay was sensitive enough to serve asa screening test in the diagnosis of CMV infection. A combination of laboratoryassays, clinical features and radiographic findings were required fordiagnosis. All patients with AML or MM had received various chemotherapiesbefore CMV infection. All but one lymphoma patient had receivedsteroids and rituximab treatment prior to CMV infection. CMV infectionepisodes were accompanied by various co-infections in 60% (12/20) ofcases. Bacterial lobar pneumonia was the most common form of co-infection.We used ganciclovir as the sole antiviral treatment in most of the infectionepisodes (18/20). Anti-CMV immunoglobulin (cytotect) was also providedto one patient because of persistent fever and dyspnea. Treatment wassuccessful in all but one of the cases, which occurred when ganciclovir wasinitiated after respiratory failure. This patient died of CMV pneumonia. Theother patients had good initial responses to antiviral treatment, but their longtermoutcome was poor. Only five patients survived after a short follow-upduration.Conclusions: In an era of intensive immuno-chemotherapy, CMV infection may become aserious threat for hematology patients. Physicians dealing with hematologicalmalignancies should be aware of CMV infection, especially for patientsreceiving rituximab and steroids.