Table 3.
Clinical and laboratory features and outcome of CMV reactivation episodes requiring specific antiviral treatment.
| Clinical and Laboratory Features | No. of Cases (All pts.) | No. of Cases (Lymphoma pts.) | No. of Cases (Myeloma pts.) |
|---|---|---|---|
| Overall incidence (%) | 54/347 (15.5%) | 30/188 (16%) | 24/159 (15%) |
| Fever (temperature >38 °C persistent at least 60 min) | 54 (100%) | 30 (100%) | 24 (100%) |
| Signs of bone marrow suppression (delay of neutrophils and/or platelet recovery or drop in neutrophils and/or platelet count after recovery) | 52 (96%) | 29 (97%) | 23 (96%) |
| End-organ disease (according to published criteria) | 5 (9.2%) | 4 (13%) | 1 (4.2%) |
| Interstitial pneumonia | 3 | 2 | 1 |
| Enteritis | 2 | 2 | 0 |
| Median day from transplant at first detection (range) | 34 (12–77) | 34 (13–70) | 34 (12–77) |
| Outcome | |||
| Treatment (*) | |||
| Ganciclovir | 15 | 8 | 7 |
| Foscarnet sodium | 15 | 10 | 5 |
| Valganciclovir | 24 | 12 | 12 |
| Polyclonal immunoglobulins | 4 | 4 | 4 |
| Need of hospital admission | 23 (42.6%) | 15 (50%) | 8 (33.3%) |
| Hematological recovery, median days (range) (**) | |||
| Neutrophils> 500/mm3 | 12 (9–22) | 11 (9–19) | 12 (9–22) |
| Platelets > 20.000/mm3 | 15 (11–94) | 16 (11–53) | 15 (11–94) |
| Alive | 50 (92.6%) | 27 (90%) | 23 (96%) |
| Dead (***) | 4 (7.4%) | 3 (10%) | 1 (4%) |
(*) Foscarnet sodium dosage: 60 mg/Kg twice daily for 14 days, than 60 mg/Kg/day for subsequent 5 days weekly for 2 weeks); Ganciclovir dosage: 5 mg/Kg twice daily for 14 days, than 5 mg/Kg/day for subsequent 5 days weekly for 2 weeks; Valganciclovir dosage: 900 mg twice daily for 14 days, than 900 mg/day for subsequent 5 days weekly for 2 weeks; (**) The occurrence of a clinically relevant CMV reactivation after ASCT, requiring antiviral treatment, leads to a delay in neutrophils and platelets recovery (p = 0.003 and p = 0.001 respectively); (***) Dead at 33, 48, 62, 89 days from transplant.