[Cytomegaloviral infection in patients with hemoblastoses]

To estimate the incidence of cytomegaloviral (CMV) infection and CMV disease in patients with acute leukemia at different stages of chemotherapy and in patients after transplantation of hemopoietic cells.

The trial was carried out in 33 patients with acute leukemia at different stages of chemotherapy, 20 patients subjected to transplantation of autologic hemopoietic cells and 21 patients who had received transplantation of allogenic hemopoietic cells. To study the dynamics of the CMV infection markers, enzyme immunoassay of the titer of the specific immunoglobulins M and G was made, detection of the viral antigen in immunofluorescence reaction and cultivation with fibroblast cell culture and determination of the cytomegalovirus DNA by polymerase chain reaction (PCR).

Before chemotherapy, up to 90% patients with acute leukemia were infected with cytomegalovirus (similar rate of infection was observed in healthy donors of hemopoietic cells). By the time of transplantation all the patients were infected with cytomegalovirus. During chemotherapy of acute leukemia, the primary infection and reactivation of latent infection occurred in 30% patients, whereas CMV disease developed in 18% patients. In case of transplantation of autologic hemopoietic cells the rate of reactivation of CMV infection (15%) was one-half of that value in patients with acute leukemia (30%). Similar trend was observed in case of development of CMV disease (5% and 18%, respectively). In case of transplantation of allogenic hemopoietic cells the incidence of reactivation of CMV infection was three times higher than in case of transplantation of autologic hemopoietic cells (47.6% and 15%, respectively, p = 0.02). The incidence of development of CMV disease in case of transplantation of allogenic hemopoietic cells was also significantly higher than in case of transplantation of autologic hemopoietic cells (28.6% and 5%, respectively, p = 0.05).

Cytomegalovirus is an infection agent responsible for severe complications of chemotherapy of acute leukemia and transplantation of hemopoietic cells in patients with hemoblastoses. Among hematological patients, the group of the highest risk of development of this complication includes recipients of transplantation of allogenic hemopoietic cells, particularly from seronegative donors.