1. PROSPECTIVE CYTOMEGALOVIRUS (CMV) MONITORING IN ACUTE MYELOID LEUKAEMIA DURING FIRST LINE THERAPY Capria S, Gentile G, Trisolini SM, Capobianchi A, Cardarelli L, Gianfelici V, Natale G, Belfanti A, Foà R, Martino P, Meloni G. Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza, University of Rome, Italy. CHEMOTHERAPY RESULTS BACKGROUND AND AIMS PATIENTS’ DETAILS Despite the extensive knowledge about the incidence and clinical impact of CMV infection in acute leukaemia patients receiving stem cell transplantation, very little is known about its role in acute myeloid leukaemia (AML) patients at onset and during first line intensive chemotherapy. Aim of our study was to analyse prospectively the incidence of active CMV infection (pp65 antigenemia) in AML patients, focusing on the role and therapeutic implications of CMV serial monitoring from diagnosis until transplant procedure. CMV active infection has an high incidence (29%) in AML patients during chemotherapy although no CMV disease was observed in our patient population. High-dose Ara-c is associated with a significant increase in CMV positivity (46% vs 18%), which, in turn, may be responsible of a delay in consolidation therapy. Our results show that CMV reactivation is not only a problem of stem cell transplantation and suggest the importance of CMV monitoring and of therapeutic guidelines since diagnosis in order to prevent the risk of CMV disease METHODS Patients’ selection: 68 consecutive AML patients at diagnosis with the exclusion of FAB M3 Active CMV infection: Any positivity of pp65 antigenemia in the peripheral blood. CMV disease: Defined as detection of CMV in tissue samples Pre-emptive treatment of active CMV infection: - Gancyclovir 10 mg/kg for 14-21 days OR - Cidofovir 5 mg/kg/week for 4 doses Recovery: Negative antigenemia in 2 consecutive controls EORTC/GIMEMA AML-12 TRIAL DCE DHiCEDIA DONOR a <50 No Allo-SCT Auto-PSCT + IL2 R Auto-PSCT R DIA YES CMV MONITORING DCE: Ara-C 100 mg/m 2 days 1-10; Etoposide 50 mg/m 2 days 1-5; Dnr 50 mg/m 2 days 1,3,5 DHiCE: Ara-C 3g/m 2 /12h days 1,3,5,7; Etoposide 50 mg/m 2 days 1-5; Dnr 50 mg/m 2 days 1,3,5 DIA: Ara-C 500 mg/m 2 days 1-6; Dnr 50 mg/m 2 days 4-6 No. Patients68 Median age (range)45 (24-61) Sex (M/F)33/35 Baseline CMV IgG IgG pos: 65 IgG neg: 3 Ara-C dose (SD/HD)39/29 PATIENTS Baseline68 Induction death7 Refractory3 CR58 Consolidation 56* Evaluable post consolidation 54** * 2 early relapses ** 2 toxic death PatientsCMV+CMV- Baseline680 Post-induction58104817% Post-consolidation549*4512% Overall58174129% By Ara-c dose58 standard3262618% high26111546% Diagnosis-consolidation (days) range 56 87 51-100 64 44-155 CMV INCIDENCE p < 0,05 * 2 patients reactivated after consolidation and 7 patients new infection All patients resulting positive for pp65 antigenemia received antiviral treatment until negativization in 2 subsequent controls Recovery from CMV infection was mandatory before administration of further chemotherapy DISCUSSION