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Background <p>Cytomegalovirus (CMV) infection is well recognized following hematopoietic stem cell transplantation but remains underappreciated in children receiving chemotherapy outside the transplant setting. Maintenance therapy in acute lymphoblastic leukemia (ALL), characterized by prolonged lymphopenia, may predispose to CMV, particularly in regions with high baseline seroprevalence.</p> Methods <p>We conducted a retrospective, single-center observational case series with focused analytic review of children (≤18 years) with ALL who developed CMV infection during maintenance chemotherapy. Clinical features, hematologic parameters including absolute lymphocyte count (ALC), viral load, management strategies, chemotherapy interruption, and short-term leukemia outcomes were analyzed.</p> Results <p>Four non-transplant pediatric ALL patients developed CMV infection exclusively during maintenance therapy. All were in leukemia remission at CMV diagnosis. CMV infection was consistently associated with treatment-related cytopenias, with lymphopenia (ALC &lt;1,000/µL). Clinical manifestations ranged from fever to gastrointestinal disease. Higher CMV viral loads were associated with end-organ involvement. All patients responded promptly to antiviral therapy achieving rapid virologic clearance. Chemotherapy interruptions were brief (7–10 days) and did not adversely affect leukemia outcomes.</p> Conclusions <p>CMV represents a clinically significant but under-recognized complication of maintenance chemotherapy in non-transplant pediatric ALL. CMV evaluation during maintenance, especially if fever is prolonged, may enable early diagnosis and effective treatment.</p>

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Cytomegalovirus Reactivation During Maintenance Therapy in Non-transplant Pediatric Acute Lymphoblastic Leukemia

  • 期刊论文

  • 发表日期：

    2026年3月5日

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  • Anuj Singh,
  • Aditi Tulsiyan,
  • Sudipto Bhattacharya,
  • Hari Gaire,
  • Vaishnavi Singh,
  • Sumi Nandwani,
  • Nita Radhakrishnan

摘要

Background

Cytomegalovirus (CMV) infection is well recognized following hematopoietic stem cell transplantation but remains underappreciated in children receiving chemotherapy outside the transplant setting. Maintenance therapy in acute lymphoblastic leukemia (ALL), characterized by prolonged lymphopenia, may predispose to CMV, particularly in regions with high baseline seroprevalence.

Methods

We conducted a retrospective, single-center observational case series with focused analytic review of children (≤18 years) with ALL who developed CMV infection during maintenance chemotherapy. Clinical features, hematologic parameters including absolute lymphocyte count (ALC), viral load, management strategies, chemotherapy interruption, and short-term leukemia outcomes were analyzed.

Results

Four non-transplant pediatric ALL patients developed CMV infection exclusively during maintenance therapy. All were in leukemia remission at CMV diagnosis. CMV infection was consistently associated with treatment-related cytopenias, with lymphopenia (ALC <1,000/µL). Clinical manifestations ranged from fever to gastrointestinal disease. Higher CMV viral loads were associated with end-organ involvement. All patients responded promptly to antiviral therapy achieving rapid virologic clearance. Chemotherapy interruptions were brief (7–10 days) and did not adversely affect leukemia outcomes.

Conclusions

CMV represents a clinically significant but under-recognized complication of maintenance chemotherapy in non-transplant pediatric ALL. CMV evaluation during maintenance, especially if fever is prolonged, may enable early diagnosis and effective treatment.