CYTOMEGALOVIREMIA AFTER AUTOGRAFTING FOR LEUKEMIA - CLINICAL-SIGNIFICANCE AND LACK OF EFFECT ON ENGRAFTMENT

One hundred and fourteen patients with leukemia (66 cytomegalovirus (C MV)-seropositive and 48 CMV-seronegative) were monitored for cytomegal oviremia by early antigen detection or conventional viral culture afte r autologous stem cell transplantation (ASCT). Twenty-two episodes of viremia were seen at 2-36 weeks (median 11) in 14 seropositive patient s. Nineteen resolved without therapy in 11 patients, Three patients wi th clinical features suggestive of CMV disease were treated with ganci clovir: viremia resolved prior to ganciclovir in one, and with 3 weeks of ganciclovir in the other two, Transient thrombocytopenia (n = 4) a nd leukopenia (n = 1) were seen in association with five episodes of v iremia. The counts recovered in all five patients; with ganciclovir (n = 2) or with spontaneous clearance of viremia (n = 3), One seronegati ve patient developed viremia which resolved spontaneously in 3 weeks. No symptoms suggestive of CMV disease were seen in any of the other pa tients, CMV serostatus or development of CMV infection did not affect hematologic recovery, In our experience, cytomegaloviremia is relative ly uncommon after autografting for leukemia, and usually does not requ ire treatment. We now do not routinely monitor leukemia patients for C MV infection after autografting, but look for viremia in CMV-seroposit ive patients with unexplained fever, drop in blood counts, lung infilt rates, or gastrointestinal symptoms.