Cytomegalovirus Infection in Adult Acute Lymphoblastic Leukemia Patients

Cytomegalovirus reactivation is an important risk factor for morbidity and mortality in immunosuppressed individuals with variable presentation from an asymptomatic state to end-organ damage. ALL patients who receive anti-CD20 monoclonal antibodies are more severely immunocompromised for a longer duration. This was a retrospective study involving review of medical records of 1500 adult ALL patients treated from 2011 to 2024 at a tertiary care teaching hospital. Seventeen out of 1500 (1.1%) adult ALL patients had CMV infection. The median age was 42 years. Thirteen out of 17 (76.4%) had CMV infection during the maintenance phase, 3/17 (17.6%) during induction and 1/17 (5.8%) after completion. The common organs affected included ocular (retinitis) in 10/17 (58.8%), liver (hepatitis) and gut (colitis) each in 3/17 (17.6%), and skin in 1/17 (5.8%). Eight out of 17 (47%) patients who had received rituximab in combination with chemotherapy, all developed CMV infection. On the last follow-up, thirteen (76.4%) patients were alive, while four (23.5%) patients had died. CMV infection was seen in 1.1% of adult ALL treated at our centre, especially during the maintenance phase, and the majority had received rituximab-based chemo-immunotherapy.