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Real-world evidence of cytomegalovirus reactivation in non-Hodgkin lymphomas treated with bendamustine-containing regimens

Cytomegalovirus (CMV) reactivation during chemotherapy or after organ or hematopoietic stem cell transplantation is a major cause of morbidity and mortality, and the risk of reactivation increases with patients’ age. Bendamustine, an alkylating agent currently used for treatment of indolent and aggr...

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Published in:Open medicine (Warsaw, Poland) Poland), 2021-04, Vol.16 (1), p.672-682
Main Authors: Pezzullo, Luca, Giudice, Valentina, Serio, Bianca, Fontana, Raffaele, Guariglia, Roberto, Martorelli, Maria Carmen, Ferrara, Idalucia, Mettivier, Laura, Bruno, Alessandro, Bianco, Rosario, Vaccaro, Emilia, Pagliano, Pasquale, Montuori, Nunzia, Filippelli, Amelia, Selleri, Carmine
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Language:English
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Summary:Cytomegalovirus (CMV) reactivation during chemotherapy or after organ or hematopoietic stem cell transplantation is a major cause of morbidity and mortality, and the risk of reactivation increases with patients’ age. Bendamustine, an alkylating agent currently used for treatment of indolent and aggressive non-Hodgkin lymphomas, can augment the risk of secondary infections including CMV reactivation. In this real-world study, we described an increased incidence of CMV reactivation in older adults (age >60 years old) with newly diagnosed and relapsed/refractory indolent and aggressive diseases treated with bendamustine-containing regimens. In particular, patients who received bendamustine plus rituximab and dexamethasone were at higher risk of CMV reactivation, especially when administered as first-line therapy and after the third course of bendamustine. In addition, patients with CMV reactivation showed a significant depression of circulating CD4 T cell count and anti-CMV IgG levels during active infection, suggesting an impairment of immune system functions which are not able to properly face viral reactivation. Therefore, a close and early monitoring of clinical and laboratory findings might improve clinical management and outcome of non-Hodgkin lymphoma patients by preventing the development of CMV disease in a subgroup of subjects treated with bendamustine more susceptible to viral reactivation.
ISSN:2391-5463
2391-5463
DOI:10.1515/med-2021-0274