Caroline Jacquy

Incidence of cmv infection and cmv disease in allogeneic transplanted patients: From no prophylaxis to preemptive treatment

Abstract During the last decade, CMV prophylaxis and preemptive therapy has considerably changed the outcome of CMV seropositive patients (pts). We have thus reviewed retrospectively our experience in 138 AlloBMT from 1984 to 2000 according to our anti CMV policy that evolved from no prophylaxis (1984–1990) to IVIG and acyclovir prophylaxis (1990–1995) and finally to prophylaxis and PCR based preemptive therapy with gancyclovir and IVIG (1995 to present). First period : 32 adult pts were allografted, 27 (72%) were CMV + , 7 pts (22%) developed a CMV disease (CMVD): 4 interstitial pneumonitis (IP), 2 pancytopenia and 1 pancytopenia with IP. Five (71%) died from CMVD (100% mortality for IP). Second period : 36 pts were allografted, 26 (72%) were CMV positive. Pts were treated for CMV infection when a positive sample by immunofluorescence or culture was reported. 4 pts (11%) were treated : 1 pancytopenia with retinitis, 2 IP and 1 skin infection with pancytopenia. 1 pt died (25%) from IP. Third period : 70 pts were allografted. PCR were monitored biweekly during 3 months after BMT. After 2 positive PCR tests on buffy coat, pts were preemptly treated. 17 pts (24%) received a preemptive treatment for positive PCR on buffy coat. 9 pts have positive PCR and cytopenia. 7 pts (10%) developed CMVD: 2 IP, 2 retinitis, 1 colitis, 1 oophoritis and 1 pt died from generalized CMVD. Those 7 pts had MUD. The pt who died from CMVD was allografted with an unrelated T depleted BM. In the setting of familial allo BMT, CMV disease is no longer a major complication in contrast with MUD.

Results from the Belgian mantle cell lymphoma registry.

Introduction: Mantle cell lymphoma is a B-cell non-Hodgkin’s lymphoma characterized by a t(11;14), resulting in overexpression of cyclin D1. Conventional chemotherapy obtains frequent (but short) remissions, leading to a poor median overall survival (OS) of 3–5 years. To obtain more information about the prevalence and current treatment of Mantle cell lymphoma (MCL) in Belgium, we collected data in a Belgian registry of MCL. Materials and methods: All Belgian MCL patients, t(11;14) and/or cyclin D1 positive, seen in hematology departments over a one-year period (April 2013–March 2014) were included. Data about patient characteristics, histology, treatment lines, and response were compiled and retrospectively analyzed. Results: Four hundred and four patients were included with a median age at diagnosis of 64 years (range 23–96 years) and a male predominance (72%). For 2013, we calculated a prevalence of at least 36.2 per million and an incidence of at least 7.0 per million in the Belgian population. Characteristics at diagnosis involved lymphadenopathy (82%), splenomegaly (44%), B-symptoms (39%), and hepatomegaly (10%). Bone marrow invasion was present at diagnosis in 77%. Stage at diagnosis was advanced in the majority of cases. The median number of treatment lines was 1. Type of first line treatment included a combination of anthracyclin and cytarabine-based regimen (34%), anthracyclin (39%), and other. Rituximab was used in 88% of first line treatments. In 44% first line treatment was followed by autologous stem cell transplantation. Conclusion: The analysis of this Belgian MCL registry provides insight in the epidemiology, demographics, and current treatment of our Belgian MCL population.