Cytomegalovirus pneumonia in patients with lymphoma

Authors

  • Roy F. Chemaly M.D., M.P.H.,

    Corresponding author
    1. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    • Department of Infectious Diseases, Infection Control and Employee Health, Unit 402, The University of Texas M. D. Anderson Cancer Center, P. O. Box 301402, Houston, TX 77230-1402
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    • Fax: (713) 745-6839

  • Harrys A. Torres M.D.,

    1. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Ray Y. Hachem M.D.,

    1. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Graciela M. Nogueras M.P.H.,

    1. Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    Current affiliation:
    1. Department of Biostatistics, U54 Puerto Rico Cancer Centre, San Juan, Puerto Rico
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  • Elizabeth A. Aguilera M.D.,

    1. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Anas Younes M.D.,

    1. Department of Lymphoma, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Mario A. Luna M.D.,

    1. Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Gilhen Rodriguez M.D.,

    1. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Jeffrey J. Tarrand M.D.,

    1. Department of Laboratory Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Issam I. Raad M.D.

    1. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Presented, in part, at the 13th International Symposium on Infections in the Immunocompromised, Granada, Spain, June 27–30, 2004.

Abstract

BACKGROUND

Even when treated with antiviral therapy, cytomegalovirus pneumonia (CMVp) is associated with high morbidity and mortality in immunocompromised patients. CMVp has been rarely reported in patients with lymphoma.

METHODS

The authors reviewed the records of patients treated at The University of Texas M. D. Anderson Cancer Center (Houston, TX) between 1997 and 2003. Collected information included demographics, use of chemotherapy, or corticosteroids, concomitant infections, and outcome.

RESULTS

Thirty-one patients with lymphoma with 36 episodes of CMVp were identified. The incidence of CMVp increased between 1997 and 2003 (0 of 1000 treated patients vs. 9 of 1000 treated patients; P = 0.07). Most episodes occurred in patients with non-Hodgkin lymphoma (89%). Most of the patients (92%) had received chemotherapy and corticosteroids (89%) before the onset of CMVp. Concomitant CMV antigenemia was detected in 11 (41%) of the 27 episodes in which testing was performed. In 19 episodes (53%), patients had coinfections within 90 days of the episode of CMVp. Coinfections were present at the onset of CMVp in 11 episodes (31%). The yield for CMV in bronchoalveolar lavage (BAL) specimens was higher with culture methods than with cytologic evaluation or immunohistochemical staining (P < 0.001). The number of CMV antigenemia tests performed increased fourfold over the study period. The CMV-attributed mortality rate was 30% (9 of 30 patients). Independent predictors of death by multivariate Cox regression analysis were high APACHE II score (> 16) at onset of CMVp (P = 0.02, hazards ratio [HR] = 15.5, 95% confidence interval [CI], 1.5–163.7), and development of toxicity to antivirals (P = 0.04, HR = 14.03, 95% CI, 1.2–169.1).

CONCLUSIONS

The incidence of CMVp in patients with lymphoma is increasing. CMV detection in BAL specimens was better with culture methods than with cytologic or immunohistochemical methods. High APACHE II score and development of antiviral toxicity were associated with a fatal outcome. Cancer 2005. © 2005 American Cancer Society.

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