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Human cytomegalovirus infection levels in glioblastoma multiforme are of prognostic value for survival.

Al's Comment:

 This is fascinating. There was a lot of talk at the recent Society of Neuro-oncology conference about cytomegalovirus and Glioblastomas. Various groups reported all or almost all gbm samples tested had this virus.  Now for the first time, this article shows that there is a very strong correlation between survival and how much virus is in the tumor. Low levels of the virus were associated with a higher survival. The group with the lowest infection level had 2 year survival rate of 63% compared to 17% in the high infection group, and the overall survivals was 20 months longer in the low infection group compared to the high infection group.

This may  mean that CMV causes or at least helps make a gbm more resistent to treatment and more deadly.

The good news is that there are relatively simple treatment available for CMV infections - such as Valcyte. There is a trial going on now to see if Valcyte can help treat GBMs. There is also a vaccine trial going on that targets CMV.


Posted on: 02/11/2013

J Clin Virol. 2013 Feb 4. pii: S1386-6532(12)00472-6. doi: 10.1016/j.jcv.2012.12.018. [Epub ahead of print]

Human cytomegalovirus infection levels in glioblastoma multiforme are of prognostic value for survival.


Rahbar A, Orrego A, Peredo I, Dzabic M, Wolmer-Solberg N, Strååt K, Stragliotto G, Söderberg-Nauclér C.
Department of Medicine Solna, Experimental Cardiovascular Research Unit, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden.

Abstract
BACKGROUND:
Patients with glioblastoma multiforme (GBM) generally live 12-15 months after diagnosis, despite maximal surgical resection, adjuvant radiotherapy, and chemotherapy. HCMV has been detected in 90-100% of GBMs. We recently found that low grade HCMV infection in GBM tumours was highly associated with survival over 18 months (case-control study). Here, we sought to determine whether low-grade HCMV infection in GBMs is associated with prolonged survival in a consecutive patient cohort, analysed retrospectively.

STUDY DESIGN:
Tumour samples from 75 consecutive GBM patients treated surgically at Karolinska University Hospital in 2004-2005 were examined by immunohistochemistry (IHC) and in situ hybridization for HCMV proteins and DNA, respectively. Tumours were graded 1-4, depending on the percentage of positive cells by IHC. Low-grade HCMV was defined as grade 1 (<25% of HCMV infected tumour cells). Time to tumour progression (TTP) and survival data were analysed with Cox regression and Kaplan-Meier models.

RESULTS:
HCMV infection was detected in 74 of 75 tumours (99%). In patients with low-grade HCMV infection, median survival was 20 months longer than in patients with high-grade infections (P=0.036, HR: 2.2), and TTP was 8 months longer (P=0.1, HR: 1.8). Two-year survival was much higher in patients with low-grade HCMV infection (63.6% vs. 17.2%, P=0.003).

CONCLUSION:
The longer survival in patients whose tumours had low-grade HCMV infection suggests that the level of HCMV infection in GBMs has a prognostic value and that HCMV may contribute to the pathogenesis of GBM.

 


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