Noa Lavi1, Doaa Okasha1, Edmond Sabo2, Ilana Oren3,4, Noam Benyamini5, Haggai Bar-Yoseph6. 1. Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel. 2. Department of Pathology, Rambam Health Care Campus, Haifa, Israel. 3. Unit of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel. 4. The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel. 5. Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 6. Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.
Abstract
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
OBJECTIVES: 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 MMpatients who did not receive bortezomib and ASCT. METHODS: We herein report three cases of heavily pretreated MMpatients, receiving daratumumab-containing combination regimens, in whom ASCT had been performed long ago and who recently developed severe CMV-related gastrointestinal disease. RESULTS: 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. CONCLUSION: 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 MMpatients.