Cytomegalovirus viremia, viruria and disease after autologous peripheral blood stem cell transplantation: no need for surveillance

A retrospective evaluation of 200 consecutive recipients of autologous peri pheral blood stem cell transplantation (PBSCT) was conducted to ascertain t he incidence, risk factors, clinical features, complications, and outcome o f cytomegalovirus (CMV) infection. A total of 26 patients (13%) developed C MV viremia (n = 5), DNAemia (n = 3), viruria (n = 18) and/or disease (n = 3 ) at a median of 45 days following stem cell infusion. None of the patients underwent surveillance testing for CMV, A diagnosis was established by cul ture and polymerase chain reaction of blood, urine or other tissue samples submitted when patients exhibited clinical features suggestive of CMV infec tion. Cytomegalovirus seropositivity prior to transplantation was the only statistically significant risk factor predicting subsequent identification of CMV (P < 0.001). The symptoms were severe enough in 23 patients to warra nt treatment with intravenous ganciclovir, Three patients developed CMV dis ease; two developed fatal CMV pneumonia and one developed CMV gastritis whi ch responded to antiviral treatment, Clinical signs and symptoms as well as viremia and viruria resolved with (20 patients) and without (three patient s) treatment in the remaining individuals. All instances of CMV viremia, DN Aemia, viruria and disease occurred within 3 months of stem cell infusion. These results demonstrate that CMV is a common pathogen after autologous PB SCT and may result in fatality in rare instances, Surveillance programs app ear to be neither useful nor cost-effective. Diagnostic evaluation should b e performed only in patients exhibiting suspicious clinical features and an tiviral chemotherapy should be administered for persistent and severe signs and symptoms.