12th Congress of the European Hematology ... - Haematologica

12 th Congress of the European Hematology Association
tor. In 50% of the episodes, patients had a normal neutrophil count, but
they were significantly immunocompromised either because of concomitant
treatment or underlying disease, thus confirming that a normal
neutrophil count does not provide a significant protection against opportunistic
infection in aggressively treated haemato-oncology and post
bone marrow transplant patients. Line removal is probably sufficient to
treat most of the septic episodes secondary to Rhodoturula, therefore
saving the patient unnecessary treatment with a potential toxic drug.
However when clinical conditions are not improving, despite line
removal, the introduction of antifungals may be needed.
0612
PROSPECTIVE CYTOMEGALOVIRUS MONITORING IN ACUTE MYELOID LEUKAEMIA
DURING FIRST LINE THERAPY
S.C. Capria, G. Gentile, S.M. Trisolini, A. Capobianco, L. Cardarelli,
G. Natale, A. Belfanti, R. Foà, P. Martino, G. Meloni
La Sapienza University, ROME, Italy
Background. Despite the extensive knowledge about the incidence and
clinical impact of CMV infection in acute leukaemia patients receiving
stem cell transplantation, very little is known about its role in acute
myeloid leukaemia (AML) patients at onset and during first line intensive
chemotherapy. Aims. Aim of our study was to analyse prospectively the
incidence of active CMV infection in AML patients, focusing on the role
and therapeutic implications of CMV serial monitoring from diagnosis
until transplant procedure. Methods. Since 8/2002, 68 AML patients at
diagnosis (M/F: 33/35; median age: 45 years, range 24-61) were consecutively
evaluated. All patients were scheduled to receive induction therapy
including standard-dose (SD) or high-dose (HD) Ara-C, Etoposide
and Daunorubicin and consolidation therapy with intermediate-dose
(ID) Ara-C and Daunorubicin. Active CMV infection was defined as any
positivity of pp65 antigenemia in the peripheral blood, while CMV disease
was defined as the detection of CMV in tissue samples. Pp65 antigenemia
monitoring was scheduled at diagnosis, post-induction and postconsolidation
chemotherapy. CMV pre-emptive treatment consisted of
Gancyclovir 5 mg/kg/12h for 12-21 days or Cidofovir 5 mg/kg/week for
a total of 4 doses. Recovery was defined as negative antigenemia in two
consecutive controls. All patients received Acyclovir prophylaxis for Herpesvirus
infections during neutropenia after chemotherapy. Results.
Among the 68 patients enrolled in the study 58 (85,3%) achieved complete
remission (CR) (3 refractory; 7 toxic deaths) and 56 received consolidation
(2 early relapses). 54/56 patients are evaluable after consolidation.
At diagnosis pp65 antigenemia was negative in all patients evaluated
. Overall incidence of positive antigenemia in the whole population
was 29% (17/58 patients): in particular 17% after induction (10/58
patients in CR) and 12% (9/54) post consolidation. Among patients positive
after consolidation only 2 were positive post induction. None of the
patients had CMV disease. Gancyclovir treatment was instituted in 8
patients, Cidofovir in 8, while in 3 patients no treatment was given.
Recovery of infection was achieved in all cases. The incidence of CMV
infection in patients receiving HD or SD Ara-c was of 46%(11/26) and
18%(6/32) respectively (p