Abstract
Background
Cytomegalovirus (CMV) is a common infection after solid-organ (SOT) and hematologic stem cell transplantation (HSCT). We correlated peripheral blood absolute lymphocyte count (PBALC) with risk of CMV infection in transplant patients.
Methods
Thirty-six SOT and 28 HSCT consecutive patients with plasma CMV viral load (VL) testing for surveillance were enrolled. Clinical variables, including PBALC, were abstracted for correlation with CMV infection.
Results
The median age was 54.5 years (IQR 40–63). Forty-three (67.2%) patients developed CMV infection (asymptomatic, 67.4%; CMV syndrome, 14%; gastrointestinal disease, 14%) at median of 4.4 months (IQR 1.4–7.7). Median VL was higher for symptomatic than asymptomatic infection (10,110 vs. 262 IU/mL, P = 0.006). PBALC <830 cells/mm3 correlated with CMV infection (sensitivity 95%; specificity 71%). Median PBALC among CMV infection patients was lower than those without infection (450 vs. 1,060 cells/mm3, P < 0.0001). Among SOT patients, PBALC <610 cells/mm3 correlated with CMV infection (sensitivity 80%; specificity 73%); median PBALC was significantly lower among those who developed CMV infection (270 and 450 vs. 1,120 cells/ mm3). Among HSCT recipients, PBALC <830 cells/mm3 correlated with CMV infection (sensitivity 100%; specificity 80%); median PBALC was lower among those who developed CMV infection (520 and 510 vs. 1,020 cells/ mm3) (Table 1).
Conclusion
In the current era when sophisticated immunologic measures are being proposed as CMV prognosticator, we highlight the clinical importance of a simple readily available PBALC.
Table 1.
CMV VL and PBALC in Patients with or Without CMV Infection
| CMV Disease | Asymptomatic CMV Viremia | No CMV infectionI | P Value | |
|---|---|---|---|---|
| SOT, N = 36 | N = 7 | N = 18 | N = 11 | |
| Median CMV VL (IQR) (IU/mL) | 32,500 (352–118,000) | 423 (297–6,315) | 0 | 0.05* |
| Median PBALC(IQR) (cells/mm3) | 270 (140–460) | 450 (388–675) | 1,120 (590–1,400) | 0.001 |
| HSCT, N = 28 | N = 3 | N = 15 | N = 10 | |
| Median CMV VL (IQR) (IU/mL) | 1,220 (426–2,520) | 884 (347–1,980) | 0 | 0.62* |
| Median PBALC (IQR) (cells/mm3) | 520 (300–560) | 510 (330–670) | 1,020 (795–3,308) | 0.03 |
PBALC, peripheral blood absolute lymphocyte count; CMV, cytomegalovirus; HSCT, hematologic stem cell transplantation; IQR, interquartile range; SOT, solid-organ transplantation; VL, viral load.
*Comparison between CMV disease and CMV viremia recipients.
Disclosures
All authors: No reported disclosures.
Session: 151. Viruses and Bacteria in Immunocompromised Patients
Friday, October 5, 2018: 12:30 PM