The International Tinnitus Journal

Overview of Cytomegalovirus Positive Patients Post-Peripheral Blood Stem Cell Transplant at Malaysia Tertiary Hospital.

Author(s): Muhamad Syafiq Izzat Hussain, Nurfarahin Mohd Sukri, Nurfadhlina Tukiman, Nurazira Osman, Nor Haniza Abdul Wahat, Noor Zetti Zainol Rashid, Rosnah Sutan, Asma Abdullah*

Background and Objectives: Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality after Peripheral Blood Stem Cell Transplant (PBSCT). This study aimed to determine the characteristics and the outcomes of CMV-positive patient’s post-PBSCT. Materials and Methods: The study population was CMV-positive post-PBSCT diagnosed by quantitative Polymerase Chain Reaction (PCR) from January 2014 until June 2016. The data was retrieved retrospectively using Integrated Laboratory Management System (ILMS) and medical records. Results: A total of 64 medical records who received peripheral blood stem cell transplant were reviewed and 30 cases (46.9%) with CMV positive. They had PBSCT between 2009 and June 2016. Mean age was 34.8± 11.14. Twenty-three (76.7%) patients underwent allogeneic and 7 (23.3%) underwent autologous PBSCT. Most of the diagnoses were Acute Myeloid Leukemia (AML) (36.7%), Acute Lymphoid Leukemia (ALL) (20.0%) and Non-Hodgkin Lymphoma (16.7%). Pre-transplant CMV Immunoglobulin G (IgG) serology was positive in 29 patients (96.7%). Post-PBSCT CMV DNA titer was detected low in 16 (53.3%) and high in 14 (46.7%). The median duration to detect CMV positivity post-PBSCT was 29 days(IQR 14.75-55.75). Interestingly, 25 (83.3%) patients were positive within 100 days. All patients had resolution of viremia within 24 weeks after the treatment. Three patients (10%) died between 1-13 months post-PBSCT. Four patients (13.3%) had CMV end-organ disease 1-5 months with median 32 days (IQR 30.75-62.25) post-PBSCT. Two patients (6.67%) had clinical diagnosis of CMV disease. Others developed complications such as mucositis (66.7%) and neutropenic sepsis (43.3%). Conclusion: Mortality rate was low (10%) among CMV-positive post-PBSCT patients. Regular monitoring for CMV viral load to patients at risk of CMV infection is required. The complications of mucositis and neutropenic sepsis can be successfully treated medically.

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