Cytomegalovirus reactivation in patients with multiple myeloma.

The introduction of novel antimyeloma agents has improved the outcome of multiple myeloma (MM) dramatically. However, it has also led to an increasing incidence of Herpesviridae family virus infections, including a high incidence of post-transplant cytomegalovirus (CMV) reactivation after treatment with novel agents. We herein retrospectively assessed the CMV reactivation in all 120 newly diagnosed patients with MM consecutively seen and treated at our hospital. CMV antigenemia tests were ordered in 58 patients depending on the clinical context, and the incidence of CMV reactivation and proven/suspected CMV disease requiring antiviral therapy was 20% (24 of 120) and 11% (13 of 120) respectively, including those without stem cell transplantation (SCT). The clinical and laboratory characteristics of these patients were compared with those in 34 CMV antigenemia-negative (CMV-negative) patients. Patients with extramedullary disease or a low absolute lymphocyte count (ALC) had a higher risk of developing CMV reactivation. In addition, the median duration from the time of MM diagnosis to CMV reactivation was 5.0 months. These results suggest that, regardless of whether or not undergoing SCT, elderly patients with MM receiving novel agents should be monitored for CMV reactivation to allow for the timely diagnosis and treatment, especially for those with extramedullary disease.

Importance of Histologic Verification of Positive Positron Emission Tomography/Computed Tomography Findings in the Follow-Up of Patients With Malignant Lymphoma.

INTRODUCTION: Posttherapy positron emission tomography/computed tomography (PET/CT) scanning in patients with malignant lymphoma remains controversial. We aimed to evaluate the utility of achieving histologic verification of positive PET/CT findings in the follow-up of patients with malignant lymphoma. PATIENTS AND METHODS: A total of 771 PET/CT scans were performed as posttherapy follow-up in 190 lymphoma patients who had experienced a complete remission at our institution. Fifty-two patients (27.3%) had (18)F-fludeoxyglucose-positive lesions on posttherapy PET/CT, and a histologic diagnosis was carried out in 32 cases (16.8%). Ten patients (5.2%) exhibited relapse of lymphoma. Twelve lesions in 11 patients (5.8%) were proven to be second primary malignancies (SPM). Eleven patients (5.8%) were proven to have benign or normal tissue lesions. RESULTS: Among the 32 histologically verified PET/CT-positive patients, the symptomatic PET/CT-positive patients (n = 10; 4 SPM, 6 lymphoma relapse) had a significantly shorter overall survival rate than the asymptomatic PET/CT-positive patients (n = 22; 7 SPM, 4 lymphoma relapse, 11 benign/normal tissue lesions) (2-year overall survival, 48.2% vs. 100%, respectively; P < .001). CONCLUSION: This study emphasizes that the histologic diagnosis should be confirmed in posttherapy PET/CT-positive patients via biopsy before adjusting the treatment regimen as a result of the high false-positive rate, including unexpected SPM or benign/normal tissue lesions.