1104. Increase Incidence of Cytomegalovirus (CMV) Enterocolitis (EC) in Multiple Myeloma (MM) Patients Undergoing Autologous Stem Cell Transplantation (ASCT)
Session: Poster Abstract Session: Infections in Hematopoietic Stem Cell Transplant and Cancer Chemotherapy Recipients
Saturday, October 22, 2011
Room: Poster Hall B1
Background: CMV-EC remains a challenging problem following allogeneic SCT; however, its clinical burden following autologous SCT (ASCT) is unknown.

Methods: We conducted a retrospective review of medical records of all MM patients who underwent ASCT at our institution between October 2009 and February 2011, to determine the incidence and clinicopathologic features of patients with CMV-EC and their response to therapy. CMV-EC was defined by the presence of CMV-specific histopathological features in gastrointestinal tract (GIT) biopsies.

Results: Twelve of 423 patients (2.8%) had CMV-EC diagnosed at a median of 34 days after ASCT (17-54 days).  CMV-EC involved the upper and lower GIT almost equally (colon 6; duodenum 4, stomach 2 and esophagus in 1). Median age was 66.5 years (53 -78 years) and 8 were male.  Melphalan-based chemotherapy was used in 10 patients. Five patients had prior ASCT and 41% received corticosteroids post-ASCT. All patients were CMV IgG seropositive and 5 had history of CMV viremia. Twenty-one concomitant infections were diagnosed in 10 patients; pneumonia (8), Clostridium difficile colitis and bacteremia (4 each), aspergillosis (3) and candidemia (2). At CMV-EC diagnosis, the median WBC, ANC and ALC were 3125/µL (range 570/6690/µL), 2350/µL (200-4500/µL), and 500/µL (200-2700/µL) respectively. Low-grade CMV viremia was noted with a median plasma CMV PCR of 1000 copies/mL only (0-4510); <2000 copies/mL (7), between 4000 and 4590 copies/mL in 3 and undetectable in 2. All responded to therapy with ganciclovir (GCV) alone (4), GCV followed by foscarnet (5) or by valganciclovir (3) for a median of 39 days of treatment (16-62). Four patients died in the 2 months following CMV-EC but none from CMV disease; causes of death were disseminated cryptococcosis, invasive aspergillosis and bacteremia, GIT bleed and cardiogenic shock (1 each).

Conclusion: CMV-EC after ASCT for MM is an uncommon complication which develops in severely immunocompromised patients with concomitant infections and responds well to antiviral therapy. Plasma CMV viral load is low and may be undetectable. Hence, CMV seropositive patients who develop GIT symptoms after ASCT should undergo GIT biopsy even in the absence of viremia.


Subject Category: O. Transplant infectious diseases

Alejandro Restrepo, M.D., Lakshmikanth Katragadda, M.D., Naveen Sanath kumar, M.D, Senu Apewokin, MD, Zainab Shahid, M.D., Bart Barlogie, MD, PhD and Elias Anaissie, MD, The Myeloma Institute for Research and Therapy/University of Arkansas for Medical Sciences, Little Rock, AR

Disclosures:

A. Restrepo, None

L. Katragadda, None

N. Sanath kumar, None

S. Apewokin, None

Z. Shahid, None

B. Barlogie, None

E. Anaissie, None

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