Status of CMV IgM Seropositivity Before and After Starting Chemotherapy in Patients with Haematological Malignancies

Abstract

Background: Even after significant improvement of management of haematological malignancy, post chemotherapy infection is still causing significant mortality and morbidity. Cytomegalovirus (CMV) is an important cause of morbidity and mortality in immunocompromised patients. This study was designed to assess prospectively the status of CMV IgM seropositivity in patients with haematological malignancy at diagnosis and after starting chemotherapy by serology test. In Bangladesh the prevalence IgG is high and IgM is low in general population but in patients with chemotherapy due to haematological malignancy status of CMV infection is not known. By finding out the infection rate we will be able to provide supportive care more effectively to patients of chemotherapy due to haematological malignancy.   Methodology: This was a prospective type of observational study and patients were selected by purposive sampling. Assessment of CMV IgG and IgM antibody test had been done at the time of 1st diagnosis and IgM antibody for CMV reassessed 6 weeks after initial chemotherapy.  Antibodies were detected by Chemiluminescence method from Virology department of BSMMU. Statistical analysis was done both manually and Windows based software device with Statistical Package for Social Science (SPSS). A p-value of <0.05 was taken as significant during data calculation. Result: During 12 months study period a total 45 patients with haematological malignancy were included in the study. Out of 45 patients, 28 were male (62%) and 17 were female (38%), male female ratio was 1.65:1. The youngest of the participants was 15 and oldest was 70 years old. The mean age of the participants was 35.77 years with SD of 16.93.  Among 45 patients of the study, ALL patients were 20 (44.4%), AML patients were 17 (37.8%), NHL patients were 5 (11.1%) and HD patients were 3 (6.7%). Before chemotherapy all participants were CMV IgG positive (100%) no one was CMV IgM Positive (0%). Six weeks after chemotherapy, 42 (93.3%) cases were CMV IgM antibody negative and only 3 (6.7%) cases were positive for CMV IgM antibody. McNemar test was done to measure the level of significance and p-value was 0.250, which was not significant statistically.  Conclusion: This small study found that all participants were CMV IgG seropositive (100%). It indicates that higher percentages of haematological malignancy patients are previously infected with CMV so there is more risk of reactivation after chemotherapy or BMT. Post chemotherapy CMV IgM seropositivity (new infection or reactivation of CMV) was low 6.7% in this study. This percentage is low in comparison with other studies. Percentage could be high if the tests were carried out with more sensitive and specific tests for CMV like PCR, pp65 antigenaemia or CMV DNA.