Should ALL patients undergoing induction therapy be screened for virus infection?

This study examined the benefit of virus surveillance in patients undergoing induction therapy for acute lymphoblastic leukemia (ALL). This study concluded that many patients were at high risk for virus infection and screening during induction therapy could be helpful.

Leukemia patients who are undergoing stem cell transplantation undergo regular screening for viral infection. Infections can be a serious complication, because treatments for leukemia, such as ALL, can impact the effectiveness of the immune system. Certain infections, such as adenovirus, cytomegalovirus (CMV) or Epstein-Barr virus (EBV), can be life-threatening.

Febrile neutropenia (unexplained fever associated with low levels of white blood cells) is common in patients treated for leukemia. Up to one-third of cases are thought to be associated with viral infections. It may be that patients undergoing induction therapy (chemotherapy to induce remission, or no sign of disease) could also benefit from viral infection screening and/or antiviral treatments.

The current study examined the records of 80 patients with ALL and 31 patients with acute myeloid leukemia. These patients had all undergone viral screening during induction therapy.

Overall, 36% of patients had at least one positive screening for a virus (EBV, CMV, or adenovirus). Of these, only 12 patients showed symptoms.

In ALL patients, there were 59 separate viral detections in 28 patients. 50.8% of these patients tested positive for EBV. 39% tested positive for CMV, and 10.2% tested positive for adenovirus. 43.3% of the patients with EBV had a recurrent episode. This was true for 39% with CMV and 33.3% for adenovirus.

Of the patients who received IVIG (a treatment to prevent viruses), 16.9% had a virus detected at screening. 63% of patients who did not receive IVIG had a virus detected.

This study concluded that ALL patients undergoing induction therapy, particularly high-risk patients or children, many benefit from screening for certain viral infections.

The current study included patients aged 0 to 25. Further studies in adults are needed to generalise findings to all patients.