Lavi Noa, Okasha Doaa, Sabo Edmond, Oren Ilana, Benyamini Noam, Bar-Yoseph Haggai
Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
Department of Pathology, Rambam Health Care Campus, Haifa, Israel.
Eur J Haematol. 2018 Aug 18. doi: 10.1111/ejh.13164.
The risk of cytomegalovirus (CMV) reactivation in multiple myeloma (MM) patients treated with bortezomib-based induction regimens is increased following autologous stem cell transplantation (ASCT). There is paucity of data regarding the risk of CMV infections in MM patients who did not receive bortezomib and ASCT.
We herein report three cases of heavily pretreated MM patients, receiving daratumumab-containing combination regimens, in whom ASCT had been performed long ago and who recently developed severe CMV-related gastrointestinal disease.
All the three patients had a prolonged CMV disease course requiring a long-term antiviral treatment. All the patients suffered from CMV colitis. One patient had concurrent CMV duodenitis and another patient had a concurrent CMV retinitis.
Novel myeloma treatments prolong patient survival and more patients with profound immunosuppression following multiple lines of therapies are seen in clinical practice. These patients may present with opportunistic infections that were rare in the past. Our findings suggest a possible association between daratumumab therapy (in combination with other immunosuppressive therapies) and severe CMV gastrointestinal disease. A longer follow-up is needed to explore long-term side effects of novel agents like daratumumab in newly diagnosed as well as heavily pretreated MM patients.
接受基于硼替佐米的诱导方案治疗的多发性骨髓瘤（MM）患者在自体干细胞移植（ASCT）后巨细胞病毒（CMV）再激活的风险增加。关于未接受硼替佐米和ASCT的MM患者发生CMV感染风险的数据较少。
我们在此报告3例接受含达雷妥尤单抗联合方案治疗的MM患者，这些患者曾接受过多次治疗，很久以前接受过ASCT，近期发生了严重的CMV相关胃肠道疾病。
所有3例患者的CMV病程延长，需要长期抗病毒治疗。所有患者均患有CMV结肠炎。1例患者并发CMV十二指肠炎症，另1例患者并发CMV视网膜炎。
新型骨髓瘤治疗方法延长了患者生存期，临床实践中可见更多经多线治疗后出现严重免疫抑制的患者。这些患者可能会出现过去罕见的机会性感染。我们的研究结果提示达雷妥尤单抗治疗（联合其他免疫抑制治疗）与严重CMV胃肠道疾病之间可能存在关联。需要更长时间的随访来探究达雷妥尤单抗等新型药物在新诊断以及曾接受过多次治疗的MM患者中的长期副作用。
