Incidence of cytomegalus virus infection in autoimmune diseases after autologous stem cell transplantation

There is no report in the literature regarding the incidence of CMV infection in autoimmune diseases patients treated with high-dose immunosuppression followed by ASCT. We report here the incidence of CMV infection in 88 consecutive ASCT for autoimmune diseases transplanted between January 2003 to May 2008 (Multiple Sclerosis (MS)=45; Type 1 Diabetes Mellitus=22; Systemic Sclerosis=9; Neuromyelitis Optica=4; Systemic Lupus Erithematous=4; Amiothrophic Lateral Sclerosis= 2; Vulgar Pemphigus=1; and Takayasu Arteritis=1). Before ASCT, all patients were seropositive for CMV. The used conditioning regimens were BEAM + hATG 30mg/Kg for 11 MS patients, and Cy 200mg/Kg + rATG 4,5mg/Kg for the other patients. All patients received peripheral blood as source of stem cells. Blood red cells and platelets infused were all irradiated and filtrated. Blood CMV pp65 antigen test was based on monoclonal antibody against the virus and immunofluorescence. CMV infection was defined as a positivity of at least one pp65 antigenemia assay at any level. In all patients, a CMVpp65 antigenemia assay was determined weekly, starting from the day when the absolute neutrophil count went above 500 x [10.sup.3]/ul, and until day 60 after ASCT. Patients with five or more positive CMV cells, patients in use of corticosteroids with any number of positive CMV cells, and patients with any clinical signs of CMV disease with any number of positive CMV cells were treated with Gancyclovir. Among the 88 transplanted patients, 18 (20,5%) presented a positive antigenemia. The first positive antigenemia presented a median of 19 days after stem cell reinfusion (range 05 to 52). The median antigenemia level at the first appearance was 2 infected cells (range 1-40). Overall, 07 patients were treated with Gancyclovir. Five were treated preemptively. Two patients had CMV pneumonits, and one died from it at D+17 after transplantation. In 61% of the cases (11 patients), CMV reactivation was asymptomatic with less them 5 cells positive and antigenemia has cleared spontaneously. Our study shows that CMV infection can reactivate in a significant proportion of seropositive patients after ASCT. However, despite the use of Antimocyte Globulin in the conditioning regimen, the rate of CMV reactivation in this subset of patients seens not be different from the 29% rate of reactivation recently encountered after ASCT for hematologic malignancies (Rossini, F., et al, Transpl Infect Dis 2005: 7: 122-125).