Akut Lösemilerde CMV Virüs Yükü Sürveyansının Yeri ve Önemi
Özet
Cytomegalovirus (CMV) reactivation occurs in 15 -80% of recipients of allogenic stem cell transplants and is associated with significant morbidity and mortality. Therefore well-defined strategies have been developed for prophylaxis, screening and pre-emptive treatment. In recent years, there has been a concern for rising frequency of CMV disease related to the advances in leukemia treatment, increased use of more potent chemotherapy protocols and longer patient survival. A surveillance study has been going on in hospitalized acute leukemia patients at Hacettepe University Internal Medicine Wards since 2005. Twice weekly CMV viral load surveillance is performed in acute leukemia patients receiving induction or consolidation therapy. We evaulated 134 patients who had at least 3 CMV PCR results during induction episode retrospectively. The cut-off value for a positive test result was >1000 copies/ml . On the average, 9.84±7.29 (min 2-max. 39) CMV PCR tests were performed for each episode in all patients. This was 7,64±4,57 (min.3-max.28) in induction, 7,47±5,82 (min.2-max.26) in consolidation groups. CMV infection was detected in 9 of 134 (%6,7) patients. 4 patients in induction group and 5 in consolidation group (p>0.05). All patients had CMV DNAemia only. Pre-emptive ganciclovir treatment was administered to 3 of 4 patients in the induction group and 1 of 5 patients who received consolidation chemotherapy. 2 of 96 patients (%2,0) in AML sub-group, 7 of 38 patients (%18,4) in ALL sub-group had CMV infection (p< 0,05). Four of 19 (%21,0) patients who had received hyperCVAD treatment, developed CMV infection (p< 0,05). Also CMV infection incidence was increased in patients who received cyclophosphamide compared to those who did not (%17.1, p< 0,05). This study showed that the surveillance CMV PCR in acute leukemia patients is not a cost effective strategy. The social security service spent 22.607 TL per patient to detect 1 case of CMV DNAemia. In conclusion, monitorization for CMV with CMV PCR was not shown to be beneficial in patients with acute leukemia during induction and/or consolidation therapy. Clinical evaluation with particular attention to patients with ALL, those receiving high dose corticosteroid or cyclophosphamide treatment and hyperCVAD protocol appears to be a more appropriate approach at the present time.
