1190. Parvovirus B19 Induced Pancytopenia†in Autologous Stem Cell Transplant (ASCT) Recipients: Diagnosis with Polymerase Chain Reaction (PCR) and Response to Intravenous Immunoglobulinís (IVIG)
Session: Poster Abstract Session: Non-CMV Viruses and Transplantation
Saturday, October 22, 2011
Room: Poster Hall B1
Background:Parvovirus B19 disease is a rare but known cause of anemia. Little is known about its role in patients (pts) with hematological cancers including ASCT recipients.

Methods:Retrospective review of the medical records of ASCT pts with myeloma who tested positive for parvovirus PCR in plasma and/or bone marrow (January 2009 - April 2011). Cases were defined by a positive parvovirus PCR and clinical and laboratory findings consistent with parvovirus infection, including pancytopenia, absent other causes for these findings.  Response was defined as resolution of clinical findings and marked improvement in pancytopenia.

Results:

Six of 19 pts with positive parvovirus PCR qualified as cases. Median age was 60 years (48-79 years) with a male/female ratio of one.  All pts had pancytopenia; however, thrombocytopenia requiring transfusions led to testing in all pts. Two presented with fever and skin rash (one later diagnosed with drug reaction with eosinophilia and systemic symptoms). Another developed unexplained lymphadenopathy and splenomegaly. Median peak plasma parvovirus PCR was 7550 copies /mL (400 to > 10 billion copies/mL).  Bone marrow hypercellularity and left shifted erythroid maturation were present in four and three pts, respectively. Median days to diagnosis after onset of pancytopenia was 19 (8-32 days) except in one whose diagnosis was delayed by 16 months. The disease was diagnosed at a median of 203 days after ASCT (19-1850 days). IVIG was started at a median of 7 days after diagnosis (mean 13 days; range 2 - 42 days) with excellent response in all pts except in one whose hemoglobin level and white blood cell counts had improved after IVIG but required splenectomy for persistent thrombocytopenia. Although viral load at diagnosis did not correlate with the severity of pancytopenia, a marked decrease in viral load was associated with response. Parvoviral disease with pancytopenia recurred in four pts who responded to additional IVIG.

Conclusion:

Parvovirus B 19 is an under recognized cause of pancytopenia in ASCT pts and thrombocytopenia-not anemia- is its leading presentation.  Unexplained cytopenias in ASCT pts should prompt PCR testing for circulating parvovirus B 19 which in turn allows for the timely initiation of effective therapy with IVIG.


Subject Category: O. Transplant infectious diseases

Lakshmikanth Katragadda, M.D.1, Zainab Shahid, M.D.1, Alejandro Restrepo, M.D.1, Naveen Sanath kumar, M.D1, Sajjad Haider, M.D.1, Jameel Muzaffar1, Saad Usmani, M.D.2 and Elias Anaissie, MD1, (1)The Myeloma Institute for Research and Therapy/University of Arkansas for Medical Sciences, Little Rock, AR, (2)The Myeloma Institute for Research and Therapy/University of Arkansas for Medical Services, Little Rock, AR

Disclosures:

L. Katragadda, None

Z. Shahid, None

A. Restrepo, None

N. Sanath kumar, None

S. Haider, None

J. Muzaffar, None

S. Usmani, None

E. Anaissie, None

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