ABSTRACT
Multiple myeloma (MM) associated with
Chagas disease is rarely described. This
disease and its
therapy suppress
T cell and
macrophage functions and increase
regulatory T cell function, allowing the increase of
parasitemia and the
risk of
Chagas Disease Reactivation (CDR). We aimed to analyze the
role of conventional (cPCR) and quantitative
Polymerase Chain Reaction (qPCR) for prospective
monitoring of T. cruzi
parasitemia, searching for markers of preemptive
antiparasitic therapy in MM
patients with
Chagas disease. Moreover, we investigated the
incidence and management of
hematological diseases and CDR both inside and outside the
transplant setting in the
MEDLINE database. We found 293 studies and included 31 of them. Around 1.9-2.0% of
patients with
Chagas disease were reported in
patients undergoing
Stem Cell Transplantation. One case of CDR was described in eight cases of MM and
Chagas disease. We monitored nine MM and
Chagas disease patients, seven under Autologous
Stem Cell Transplantation (ASCT), during 44.56±32.10 months (mean±SD) using parasitological
methods, cPCR, and qPCR. From these
patients, three had
parasitemia. In the first, up to 256 par Eq/mL were detected, starting from 28 months after ASCT. The second
patient dropped out and died soon after the
detection of 161.0 par Eq/mL. The third
patient had a positive
blood culture. Benznidazole induced fast negativity in two cases; followed by notably lower levels in one of them. Increased T. cruzi
parasitemia was related to the severity of the underlying
disease. We recommend
parasitemia monitoring by qPCR for early introduction of preemptive
antiparasitic therapy to avoid CDR.