Guizhi Fuling capsule can induce apoptosis of myeloma cells through the mitochondrial apoptosis pathway

Objective To observe the effects of Guizhi Fuling capsule(GZFLC)on RPMI 8226 cells and explore the mechanisms.Methods Cell Counting Kit-8(CCK-8)assays and flow cytometry were used to detect the viability and apoptosis levels of RPMI 8226 cells.The effects on mitochondria were examined by ROS and JC-1 assays.Western blotting was used to detect the expression of B cell lymphoma-2(Bcl-2),Bax,cleaved caspase-3,and Apoptotic protease-activating factor 1(Apaf-1).Results GZFLC drug serum decreased the viability and increased the apoptosis of RPMI 8226 cells.In addition,this drug increased ROS levels and decreased the mitochondrial membrane potential(MMP).Western blotting showed that the Bcl-2/Bax ratios were decreased in the GZFLC drug serum-treated groups,whereas the expression levels of cleaved caspase-3 and Apaf-1 were increased.Conclusion GZFLC promoted apoptosis of myeloma cells through the mitochondrial apoptosis pathway.

Autocrine Production of Interleukin-6: A Mechanism of Interleukin-6 Independence in Dexamethasone-Resistant 7TD1 Murine Myeloma Cells

Several factors could contribute to proliferation of multiple myeloma (MM) cells independent of interleukin-6 (IL6) in the later stages of the disease. Our previous studies established a dexamethasone-resistant 7TD1 cell line (7TD1-Dxm) and have shown that one mechanism of resistance to dexamethasone is due to inhibition of cytochrome c release. We have also observed that 7TD1-Dxm cells proliferate independently of externally-added IL6. This study therefore aimed to elucidate the mechanisms responsible for IL6-independent proliferation in 7TD1-Dxm cells. Our results indicated that 7TD1-Dxm cells produced IL6 in an autocrine fashion. We have observed that dexamethasone-resistant 7TD1 cells become dexamethasone-resistant and IL6-independent for proliferation concomitantly. This strongly suggests that production of IL6 by 7TD1-Dxm cells may play an important role in the development of dexamethasone resistance. Consequently, further investigation of the molecular mechanisms responsible for IL6 production may be helpful in delineating the mechanisms leading to dexamethasone resistance.

Pleural effusion,ascites,colon ulcers and hematochezia:What we can learn from the diagnostic process of a patient with plasma cell myeloma:A case report

BACKGROUND Plasma cell myeloma(PCM)is characterized by hypercalcemia,renal impairment,anemia,and bone destruction.While pleural effusion,ascites,abdominal pain,and bloody stool are common manifestations of lung disease or gastrointestinal disorders,they are rarely observed in patients with PCM.CASE SUMMARY A 66-year-old woman presented with complaints of recurrent chest tightness,wheezing,and abdominal bloating accompanied by bloody stools.Computed tomography revealed pleural effusion and ascites.Pleural effusion tests showed inflammation,but the T-cell spot test and carcinoembryonic antigen were negative.Endoscopy showed colonic mucosal edema with ulcer formation and local intestinal lumen stenosis.Echocardiography revealed enlarged atria and reduced left ventricular systolic function.The diagnosis remained unclear.Further testing revealed elevated blood light chain lambda and urine immunoglobulin levels.Blood immunofixation electrophoresis was positive for immunoglobulin G lambda type.Smear cytology of the bone marrow showed a high proportion of plasma cells,accounting for about 4.5%.Histopathological examination of the bone marrow suggested PCM.Flow cytometry showed abnormal plasma cells with strong expression of CD38,CD138,cLambda,CD28,CD200,and CD117.Fluorescence in situ hybridization gene testing of the bone marrow suggested 1q21 gene amplification,but cytogenetic testing showed no clonal abnormalities.Colonic mucosa and bone marrow biopsy tissues were negative for Highman Congo red staining.The patient was finally diagnosed with PCM.CONCLUSION A diagnosis of PCM should be considered in older patients with pleural effusion,ascites,and multi-organ injury.

From Myeloma to Plasma Cell Leukemia, Persistent Inequalities

Multiple myeloma (MM) is both a complex and heterogeneous disease. Cytogenetic and molecular abnormalities lead to resistance to treatment and transformation to plasma cell leukemia, which is defined by the presence in circulating blood of plasma cells over 2 G/L, or more than 20% of leukocytes. It is an uncommon hematological malignancy with a poor prognosis. Against this backdrop, we report an observation of multiple myeloma transformed into plasma cell leukemia diagnosed at the Hôpital Principal de Dakar (HPD) that occurred on a 64-year-old man with a history of thyroidectomy followed for multiple myeloma presenting with Salmon et Durie stage IIIA and ISS stage I. Despite a marked improvement in management strategy, myeloma remains an almost invariably incurable disease. However, the development of genetic and molecular biomarkers is necessary to improve its prognosis.

Nicotinamide-Induced Apoptosis Can Be Enhanced by Melatonin in Mouse Myeloma Cells

The mechanism of apoptosis induced by nicotinamide was investigated by treating mouse myeloma cells （Sp2/0） with various concentrations of nicotinamide. The typical hallmarks of apoptosis, including chromatin condensation and DNA fragmentation, were detected when cells were treated with nicotinamide at concentrations of 30, 40, 50, and 60 mmol/L. The apoptosis percentage increased with increasing nicotinamide concentration. Interestingly, the strong antioxidant melatonin did not restrain the apoptosis induced by nicotinamide in mouse myeloma cells but greatly increased the induction of nicotinamide on apoptosis. When cells were preincubated with 0.1, 1, and 10 mmol/L melatonin before nicotinamide induction, the percentage of apoptosis induced by 50 mmol/L nicotinamide markedly increased with increasing melatonin concentration. These results suggest that apoptosis induced by nicotinamide has no relationship with oxida tive stress and melatonin could enhance nicotinamide-induced apoptosis in mouse myeloma cells by stimulating cell division in a certain manner. Nicotinamide may provide a new method to treat some kinds of tumors with no damage to normal tissues.

Hepatic failure caused by plasma cell infiltration in multiple myeloma

Although plasma cell infiltration is not rare in autopsy of patients with multiple myeloma (MM), it is very rarely detected in living patients. This is because MM rarely causes significant liver dysfunction that requires further evaluation. A 49-year-old man presented with acute renal failure and was diagnosed with kappa light chain MM stage B.Thalidomide and dexamethasone were initiated.The patient developed a continuous increase in bilirubin that led to severe cholestasis.A liver biopsy revealed plasma cell infiltration.He then rapidly progressed to liver failure and died.Treatment options are limited in MM with significant liver dysfunction.espite new drug therapies in MM,those patients with rapidly progressive liver failure appear to have a dismal outcome.

Identify multiple myeloma stem cells: Utopia?

Multiple myeloma(MM) is a hematologic malignancy of monoclonal plasma cells which remains incurable despite recent advances in therapies. The presence of cancer stem cells(CSCs) has been demonstrated in many solid and hematologic tumors, so the idea of CSCs has been proposed for MM, even if MM CSCs have not been define yet. The existence of myeloma CSCs with clonotypic B and clonotypic non B cells was postulated by many groups. This review aims to focus on these distinct clonotypic subpopulations and on their ability to develop and sustain MM. The bone marrow microenvironment provides to MM CSCs self-renewal, survival and drug resistance thanks to the presence of normal and cancer stem cell niches. The niches and CSCs interact each other through adhesion molecules and the interplay between ligands and receptors activate stemness signaling(Hedgehog, Wnt and Notch pathways). MM CSCs are also supposed to be responsible for drug resistance that happens in three steps from the initial cancer cell homing microenvironment-mediated to development of microenvironment-independent drug resistance. In this review, we will underline all these aspects of MM CSCs.

Establishment and biological characteristics of human multiple myeloma cell line CZ-1

Background There were only 3 multiple myeloma (MM) cell lines established in China. In this study,we succeeded in establishing a novel MM cell line and analyzed its biological characteristics. Methods Mononuclear cells isolated from the peripheral blood (PB) and bone marrow (BM) of a patient with advanced MM (λ light chain type) were cultured in medium. Cell morphology was analyzed by Wright-Giemsa-staining and cytochemical staining,immunophenotyping by flow cytometry and cytogenetic analysis by chromosome RHG-banding technique. Quantitative fluorescent polymerase chain reaction (PCR) was used to detect Epstein - Barr virus (EBV) DNA. Results The established cell line could survive and proliferate in the presence of feeder cells or conditioned medium. The cells secreted λ light chain and were negative for EBV. The Wright-Giemsa-staining showed typical plasmablast or plasma cell morphology. The cytochemical staining of the cells showed the following reactivity patterns: positive for acid phosphatase,negative for myeloperoxidase. The immunoprofile of the cells was concordant with that of MM cells: positive for CD_ 10 ,CD_ 28 ,CD_ 38 ,CD_ 138 ,CD_ 56 ,CD_ 49d ,CD_ 44 ,CD_ 54 and CD_ 58 ,negative for CD_ 19 , CD_ 40 ,CD_ 95 ,CD_ 95L ,CD_ 34 ,CD_2 and CD_5. The cytogenetic analysis showed complex chromosome abnormality of i (1q+),8q+,13q+,i (17q),i (18q) and +M. There was no difference in morphology,immunophenotype and cytogenetics between cells from PB and BM. Conclusions An MM cell line secreting λ light chain named CZ-1 was established. The cells from both PB and BM have the same biological characteristics.

Effects of arsenic trioxide on voltage-dependent potassium channels and on cell proliferation of human multiple myeloma cells

Arsenic trioxide （ATO） can induce cellular apoptosis ,and inhibit the activities of multiple myeloma （MM）cells in vitro, but how it works is not very clear. Recent studies showed that ATO worked on the voltagedependent potassium channel and L-type calcium channel in myocardial cells, but the effect of ATO on ion channels of tumor cells was rarely reported. As the potassium channel plays an important role in controlling cell proliferation, we studied the effects of ATO on the voltage-dependent potassium current （Ikv） of the voltage-dependent potassium channel in an MM cell line, and probed into the relationship between changes of the Ikv caused by ATO and cell proliferation.

Determining the optimal time for bortezomib-based induction chemotherapy followed by autologous hematopoietic stem cell transplant in the treatment of multiple myeloma

In our study, we determined the efficacy of bortezomib-based induction therapy followed by autologous stem cell transplant （ASCT） in newly diagnosed and relapsed/refractory （R/R） multiple myeloma （MM） patients and compared the advantages of early versus late transplant. We used a retrospective analysis to examine 62 patients, including 46 cases of newly diagnosed MM （early transplant group） and 16 cases of relapsed/refractory MM （late transplant group）. All of these patients received bortezomib-based induction therapy followed by ASCT. The efficacy and side effects of the treatment regimen were analyzed. Patients＇ overall survival （OS） and progression-free survival （PFS） times were determined. The ratio of complete remission to near-complete remission （CR/nCR） was 69.5% versus 56.2% （P=0.361）, respectively, for the early transplant group versus the late transplant group, respectively, after receiving bortezomib-based induction therapy; the overall response rates of the two group were 91.3 % and 81.2 %, respectively （P=0.369）. After receiving ASCT, the CR/nCR of the two groups increased to 84.8% and 81.3%, respectively. The median time required for neutrophil engraftment of the early transplant group and the late transplant group was 11 and 14.5 days, respectively （P=0.003）; the median time required for platelet engra^nent was 13 and 21.5 days （P=0.031）, respectively. There were no significant differences in the toxic side effects observed during induction therapy and ASCT between the two groups. The OS of the two groups was not statistically different （P=0.058）. The PFS of the early transplant group and the late transplant group was 41.6 and 26.5 months, respectively （P=0.008）. Multivariate analysis demonstrated that the time of receiving ASCT, the types of M protein, and the International Staging System （ISS） stage were all independent factors that influenced PFS. In conclusion, patients in a suitable condition for ASCT should be recommended to have an early ASCT immediately after diagnosis.

Peripheral blood stem cell mobilization in multiple myeloma: Growth factors or chemotherapy?

High-dose therapy followed by autologous hematopoietic stem cell(HSC) transplant is considered standard of care for eligible patients with multiple myeloma. The optimal colection strategy should be effective in procuring sufficient HSC while maintaining a low toxicity profile. Currently available mobilization strategies include growth factors alone,growth factors in combination with chemotherapy,or growth factors in combination with chemokine receptor antagonists; however,the optimal strategy has yet to be elucidated. Herein,we review the risks and benefits of each approach.

Triptolide Inhibits Cell Growth and Induces G0-G1 Arrest by Regulating P21wap1/cip1 and P27 kip1 in Human Multiple Myeloma RPMI-8226 Cells

Objective： To investigate the effects of triptolide（TPL） on cell growth, cell cycle and the expressions of p21wapl/cipl and p27kipl. Methods： MTT assay was used to determine the cell viability after triptolide treatment in human multiple myeloma RPMI-8226 cells. The effect on cell cycle distribution was determined by flow cytometry. Semi-quantitative reverse transcription-PCR was used to examine the mRNA expressions of p21wapl/cipl and p27kipl. The protein expressions of p21 wapl/cipl and p27kipl were determined by Western blot. Results： Triptolide of varying concentrations induced cell viability inhibition in dose- and time-related fashion and caused Go- G1 phase arrest of cell cycle progression in RPMI-8226 cells. These effects accompanied with up-modulation of the expressions of p21 wapl/cipl and p27kipl. Conclusion： These results suggest that triptolide inhibit cell proliferation and cell cycle progression via up-regulating p21wapl/cipl and p27kipl and triptolide may exert its anti-cancer activity through this pathway.

Multiple myeloma mesenchymal stromal cells: Contribution to myeloma bone disease and therapeutics

Multiple myeloma is a hematological malignancy inwhich clonal plasma cells proliferate and accumulate within the bone marrow. The presence of osteolytic le-sions due to increased osteoclast(OC) activity and sup-pressed osteoblast(OB) function is characteristic of the disease. The bone marrow mesenchymal stromal cells(MSCs) play a critical role in multiple myeloma patho-physiology, greatly promoting the growth, survival, drug resistance and migration of myeloma cells. Here, we specifically discuss on the relative contribution of MSCs to the pathophysiology of osteolytic lesions in light of the current knowledge of the biology of my-eloma bone disease(MBD), together with the reported genomic, functional and gene expression differences between MSCs derived from myeloma patients(pMSCs) and their healthy counterparts(dMSCs). Being MSCs the progenitors of OBs, pMSCs primarily contribute to the pathogenesis of MBD because of their reduced osteogenic potential consequence of multiple OB inhibi-tory factors and direct interactions with myeloma cells in the bone marrow. Importantly, pMSCs also readily contribute to MBD by promoting OC formation and ac-tivity at various levels(i.e., increasing RANKL to OPG expression, augmenting secretion of activin A, uncou-pling ephrinB2-EphB4 signaling, and through augment-ed production of Wnt5a), thus further contributing to OB/OC uncoupling in osteolytic lesions. In this review, we also look over main signaling pathways involved in the osteogenic differentiation of MSCs and/or OB activity, highlighting amenable therapeutic targets; in parallel, the reported activity of bone-anabolic agents(at preclinical or clinical stage) targeting those signaling pathways is commented.

Selinexor, Carfilzomib, Pomalidomide, and Dexamethasone as a Salvage Regimen for Refractory and Relapsed Multiple Myeloma with Plasma-Cell Leukemia Transformation: A Case Report and Literature Review

Refractory and relapsed multiple myeloma (RRMM) with plasma-cell leukemia (PCL) transformation is highly aggressive and resistant to conventional therapy. Novel therapeutics are needed for RRMM-transformed PCL. Selinexor [an oral exportin 1 (XPO1) inhibitor], carfilzomib (a second-in-class proteasome inhibitor), pomalidomide (third generation of immunomodulatory drug) are usually used for RRMM, but there are no reports on their application in PCL transformation. We describe a 62-year-old male initially diagnosed with MM IgD-lambda type with complex karyotype and extramedullary plasmacytoma in 2020, and relapsed after five months of autologous stem cell transplantation. Despite the use of various therapies, the patient rapidly developed into PCL over a 4-month period. The patient was started on selinexor, carfilzomib, pomalidomide, and dexamethasone (XKPd) combination as a salvage regimen in July 2021. He achieved fast response in first cycle. Then, he fulfilled third cycle of consolidation treatment and got four-month remission. The success of XKPd therapy in achieving a good response suggests its utility in RRMM transformed-PCL patients, who have exhausted various combinations of drug regimens and have historically poor survival outcomes.

Bcl-1 Rearrangement and Cyclin D1 Protein Expression in Multiple Myeloma Precursor Cells

The rearrangement of Bcl-1 gene (Bcl-1/IgH rearrangement) and expression of cyclin D1 in multiple myeloma (MM) precursor cells were studied and the role of cyclin D1 in the pathogenesis of MM was investigated. The BCL-1 rearrangement and cyclin D1 protein expression in 15 cases of MM were detected. By using hemi-nested polymerase chain reaction (PCR) the genomic DNA from fresh peripheral blood and bone marrow was amplified and the expression of cyclin D1 in the smears was detected by using immunohistochemical method. Ten volunteer with normal bone marrow served as control group. The results showed Bcl-1 rearrangement was detectable in 3/15 (20 %) MM patients and cyclin D, expression in 4/15 (27 % ) MM patients. BeLl-1 rearrangement and cyclin D1 protein expression were also detected in MM precursor cells. No overexpression of cyclin D1 or the rearrangement of the BeL-1 gene was found in the 10 volunteers. It was concluded that Bel-1 rearrangement and cyclin D1 protein overexpression were detected in MM precursor cells, speculating that overexpression of cyclin D1 protein may play an initial (critical) role in the pathogenesis of MM.

Comparison of Cell Morphology and Flow Cytometry in the Diagnosis of Multiple Myeloma

Objective: To investigate the value of cell morphology and flow cytometry in the diagnosis of Multiple myeloma (MM). Methods: 166 newly diagnosed MM patients were retrospectively analyzed, and the proportion of plasma cells detected by flow cytometry and cell morphology in these patients was statistically analyzed. Results: All patients were divided into three groups according to the proportion of plasma cells detected by cell morphology: group A (≥30%), group B (≥10% and <30%), and group C (<10%). 1) In all patients and group A, B and C, the proportion of plasma cells detected by cell morphology was all correlated with that detected by flow cytometry. 2) The proportion of plasma cells detected by cell morphology in group A and group B was higher than that by flow cytometry, while there was no significant difference in group C. 3) The sensitivity of plasma cells detected by flow cytometry in group A, B and C was 88.7%, 51.2% and 10%, respectively. 4) According to the immunophenotypic analysis, the immunophenotypic characteristics were similar, all of them were CDl9 - CD38 + CDl38 + CD56 +/- CD45dim ~ -. Conclusion: There is a certain correlation between the two detection methods. The quantitative detection of myeloma cells by cell morphology is better, and the qualitative detection by flow cytometry is better. Combined with the two detection methods, the detection rate of multiple myeloma can be significantly improved.

Successful Treatment of Low-Dose Lenalidomide Maintenance Therapy Followed by Second Autologous Peripheral Blood Stem Cell Transplantation in Heavily Treated Multiple Myeloma

Recently, the prognosis of multiple myeloma has been improved by using high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (ASCT), bortezomib, and immunomodulatory drugs including thalidomide and lenalidomide. On the other hand, treatment strategy remains difficult for refractory and relapse cases. Here, we report the successful treatment of low-dose lenalidomide maintenance therapy followed by salvage ASCT in a heavily treated patient with multiple myeloma. This 58-year-old woman with IgG-λ multiple myeloma had a 5th recurrence in June, 2011. It was 7 years post-diagnosis, and she had received conventional therapies such as VAD, MP therapy. Furthermore, the patient had already been treated with ASCT, bortezomib, and thalidomide therapy. At the 5th recurrence, she had extramedullary plasmacytoma in the left orbit. She initially received bortezomib and dexamethasone therapy as induction therapy. After peripheral blood stem cell collection, radiation therapy was performed. The patient then received a second ASCT. Three months later, the response was very good partial response. Finally, the patient was treated with 5 mg/day lenalidomide orally as a maintenance therapy, and she achieved stringent complete response after 2 months according to International Myeloma Working Group response criteria. Low-dose lenalidomide maintenance therapy might be also useful for ASCT as salvage therapy, although further studies are warranted.

Altered gene expression reveals molecular mechanisms underlying oridonin-induced apoptosis of multiple myeloma LP-1 cells

Objective: To investigate the effect of oridonin on proliferation and invasion of human multiple myeloma LP-1 cells and the underlying mechanism. Methods: LP-1 cells in culture medium in vitro were treated with oridonin at the different concentration. Cell proliferation was measured by Microwave Theory and Techniques (MTT) assay and cell apoptotic rate was detected by flow cytometry. Morphology of cell apoptosis was observed by transmission electron microscope. Expressions of Bax, Bcl-2, Caspase-3, NF-κB as well as I-κB mRNA were detected by real-time PCR. Results: The MTT assays and flow cytometry revealed that oridonin could inhibit the growth of LP-1 cells and cause apoptosis significantly; the suppression was both in time- and dose-dependent manner. Marked morphological changes of cell apoptosis were found under a transmission electron microscope after the cells were treated with oridonin at 25 μmol/L for 24 h. Along with the apoptotic process, Bcl-2, Caspase-3,NF-κB gene expressions were down-regulated (P<0.05). On the contrast, the Bax and I-κB gene expressions were up-regulated (P<0.05). Conclusion: Oridonin could inhibit the proliferation of LP-1 cells via inducing apoptosis. We concluded that oridonin induces apoptosis in LP-1 cells via activation of caspase-3 as well as down-regulation of Bcl-2 and up-regulation of Bax expression. The results suggested that oridonin could induce apoptosis of LP-1 cells through mitochondria- and caspase3-dependent pathways. Meanwhile, the inhibition of NF-κB and the activation of I-κB indicate pro-apoptotic stimuli. In one word, oridonin might be an important potential anti-myeloma reagent.

Darbepoietin-Alfa after High-Dose Melphalan and Autologous Hemopoietic Progenitor Cell in Multiple Myeloma Patients: A Pilot Study

We describe the effects of Darbepoietin-alfa (Darbe) administration in Multiple Myeloma (MM) after autologous he-mopoietic progenitor cell transplantation (AHPCT). 26 MM patients undergoing AHPCT entered this study. 34 hemo-globin (Hb)-matched patients who had not received recombinant human erythropoietin (Epo) or Darbe and were treated with the same protocol were retrospectively selected for comparative data. Darbe (150 micro g total dose/weekly) was initiating in four weeks after AHPCT, with the aim of achieving an Hb level of ≥11 g/dl. The time to response to Darbe therapy was longer in the patients with Hb < 10 g/dL (p = 0.05) and with endogenous Epo levels ≤ 50 mU/ml (p = 0.0098). Hb level on day 60 and 90 after AHPCT, was faster for Darbe recipients (12.5, range 9.4 - 15.4, vs 10.6, range 8.8 - 13.4 g/dL, p = 0.0001, and 13.5, range 12.3 - 14.3, vs 12, range 9.8 - 14 g/dL, respectively, p = 0.0001). The need for Red Blood Cells transfusion, included in the period of 30 - 90 days post- AHPCT was similar (p = ns). This study demonstrates the accelerating effect of Darbe on Hb increase in the setting evaluated and shows that this effect signify- cantly depends on the endogenous Epo level at the start of treatment. The strategy of giving Darbe around 1 month after high-dose melphalan (HDM) doesn’t reduce RBC transfusion requirement.

Cytomegalovirus reactivation after autologous stem cell transplantation in myeloma and lymphoma patients:A single-center study

AIM: To determine the incidence of and the risk factors for cytomegalovirus(CMV) symptomatic infection and end-organ disease after autologous stem cell transplantation(ASCT).METHODS: A total of 327 consecutive non CD34+ selected autografts performed from the Hematology and Stem Cell Transplantation Unit of Regina Elena National Cancer Institute of Rome(Italy) in the period comprised between January 2003 to January 2015, were reviewed. Over the 327 autografts, 201 were performed in patients with multiple myeloma, whereas the remaining 126 in patients affected by non-Hodgkin's lymphoma and Hodgkin's lymphoma. The patients who underwent an ASCT for an acute leukemia(n = 20) in the sameperiod were excluded from this analysis. CMV DNA load in the blood has been determined by polymerasechain reaction in the case of a clinical suspicion of reactivation, therefore, no routine monitoring strategy was adopted. In the presence of signs and symptoms of CMV reactivation an antiviral treatment was performed.RESULTS: Overall, 36 patients(11%) required a specific antiviral treatment for a symptomatic CMV reactivation(n = 32) or an end-organ disease(n = 4). We observed 20 and 16 cases of CMV reactivation among lymphoma(16%) and myeloma patients(8%), respectively. Among cases of end-organ disease, 3 were diagnosed as interstitial pneumonia and one remaining case as hemorrhagic enteritis. All cases of CMV reactivation were observed in Ig G seropositive patients, with no documented cases of primary CMV infection. All patients were treated with a specific antiviral therapy, with a global rate of hospitalization of 55%; four patients received intravenous immunoglobulins. Transplantrelated mortality was significantly higher in patients who experienced a CMV reactivation(8.4% ± 4.7% vs 1.7% ± 0.8%; P = 0.047). In univariate analysis, a pretransplant HBc Ig G seropositivity, a diagnosis of T-cell non-Hodgkin's lymphoma and higher median age at transplant were significantly associated with the risk of developing a clinically relevant CMV infection requiring specific antiviral therapy(P < 0.001, P = 0.042 and P = 0.004, respectively). In multivariate analysis, only a pretransplant HBc Ig G seropositivity(OR = 8.928, 95%CI: 1.991-33.321; P = 0.023) and a diagnosis of T-cell nonHodgkin's lymphoma(OR = 4.739, 95%CI: 1.511-11.112; P = 0.042) proved to be independent predictors of a post-transplant clinically relevant CMV reactivation. CONCLUSION: A symptomatic CMV infection can occur in about 11% of adult patients with lymphoma or myeloma undergoing ASCT. A pre-transplant HBc Ig G seropositivity and a diagnosis of T-cell non-Hodgkin's lymphoma should be considered as independent predictor factors of CMV reactivation.