Cytomegalovirus infection in patients with lymphoma: An important cause of morbidity and mortality

Background: Cytomegalovirus (CMV) antigenemia (CMV-A) and CMV disease (CMV-D), known causes of morbidity and mortality among patients with leukemia and recipients of hematopoietic stem cell transplantations, are described sporadically in patients with lymphoma. We sought to determine the risk factors and outcome of CMV-A and CMV-D among patients with lymphoma. Patients and methods: We conducted a retrospective cohort study with such patients identified between 1997 and 2003 at The University of Texas M. D. Anderson Cancer Center. Seventy-one patients with 82 episodes of CMV-A and/or CMV-D (CMV-A in 38 episodes and CMV-D in 44 episodes) were studied. Results: Cytomegalovirus antigenemia and/or CMV -D were more common among patients with non-Hodgkin's lymphoma than among those with Hodgkin's disease (P = 0.01). Most CMV infectious episodes occurred in patients who had active (88%) and stage III/IV lymphoma (84%). Eleven of 65 patients (17%) with outcome data died with CMV-A and/or CMV-D. Death with CMV infection was more common among patients with CMV-D than among those with CMV-A (29% vs. 3%, respectively, P = 0.005). Predictors of death by univariate analysis included intensive care unit admission, mechanical ventilation, high antigenemia burden, relapse of CMV-A and/or CMV-D, and antiviral-associated toxicity (all P < 0.05). Multivariate analysis identified antiviral toxicity as the only independent predictor of death (P = 0.01). Conclusion: In an era of intense and pleiotropic immunosuppressive therapy in patients with lymphoma, CMV-A and CMV-D are significant infections. Preventive strategies might be warranted for patients at risk.