Researchers characterized clinical patterns and outcomes in a series of patients with thrombocytopenia that appeared to be associated with cytomegalovirus (CMV), and found that anti-CMV therapy showed the highest response rate among examined treatments. These findings were published in the British Journal of Haematology.

In their report, the researchers wrote that “to the best of our knowledge, this is the largest case series on adult immunocompetent patients with CMV-associated thrombocytopenia, both in terms of newly reported cases and reviewed cases from the literature.”

While CMV infection is not uncommon and often occurs without symptoms in patients who are immunocompetent, it can be associated with the development of thrombocytopenia. The mechanisms by which this may occur are not fully understood.

The research team performed a systematic literature review and examined patient data from hematology centers throughout Israel. They identified 23 studies that described 25 cases of adult patients with CMV-related thrombocytopenia who were otherwise immunocompetent. The exploration of hematology centers added data for another 5 patients to the analysis.


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The 30 patients examined in this analysis had a median age of 33 years (range, 18-80); 73% were men. Of the 27 patients with complete data, 74% presented with typical CMV-associated symptoms. Other laboratory features included the presence of atypical lymphocytes in blood (21 patients), elevated transaminase levels (19 patients),  and splenomegaly (11 patients).  

Patients had a median of 2 lines of therapy (range, 0-8) for thrombocytopenia. Response rates differed by treatment. A total of 11 patients had received an anti-CMV treatment in any line of therapy, and this group showed a response rate of 82% to anti-CMV treatment. However, among the 26 patients who received a steroid-containing treatment in the first line, the response rate was only 31%.

Of the 4 patients given thrombopoietin receptor antagonists (TPO-RA), 3 responded to treatment. Some patients received intravenous immunoglobulin (IVIG) treatment in addition to another therapy; of the 2 patients who received IVIG alone, 1 responded.

The researchers also performed a univariate analyses to determine if there were predictors for response to steroid-containing treatments, but they found none among the variables they evaluated. They also examined results for a subset of 15 patients for whom CMV infection was confirmed by polymerase chain reaction analysis, but reported results were similar to those of the full study population.

“In our series, CMV-associated thrombocytopenia was relatively corticosteroid-insensitive, while both anti-CMV therapy and TPO-RA exhibited excellent efficacy, suggesting that those agents should be introduced earlier in the therapeutic course,” the researchers concluded in their report.

Reference

Shragai T, Lebel E, Deshet D, et al. Characteristics and outcomes of adults with cytomegalovirus-associated thrombocytopenia: a case series and literature review. Br J Haematol. Published online August 3, 2020. doi:10.1111/bjh.17017