683. Cytomegalovirus Infection in Patients with Chronic Lymphocytic Leukemia
Session: Abstracts: Virology
Friday, October 22, 2010
Background: CMV infection may cause a significant morbidity & mortality among HSCT recipients. Patients (pts) with CLL who are receiving T cell depleting agents may be at high risk of developing this infection. Data on characteristics, risk factors, & outcome of CMV infection among these pts is lacking.

Methods: We reviewed the records of pts with CLL and CMV antigenemia (CMV-A) or CMV disease (CMV-D) identified from  microbiology database between Jan 1998 & Dec 2009.

Results: Overall 122 pts with a total of 154 episodes of CMV infection were identified. Median age was 65 y (45-84y). Most pts (79%) had progressive cancer, lymphopenia (ALC<200) (60%), and were on chemotherapy (97%); mainly rituximab based regimen (59%),alemtuzumab (48%) and/or on steroids (44%). Most pts (84%) had CMV-A with median of 12 cells (1-7228) while 20 (16%) had CMV-D, mainly pneumonia (19/20) with concomitant CMV-A in 14 pts with a median of 27 (2-6837). When compared to CMV-A, more pts with CMV-D were on steroids (p<0.001), in ICU (p=0.011), had bacterial or fungal pneumonia (p<0.05), and had a trend for higher median peak of CMV-A (27 vs. 12; p=0.07). Multivariate analysis (MVA) identified steroids as the only predictor of CMV-D (OR 9.7, CI 2.1- 44.3, p=0.003). Mortality at 60 days was 25% and was higher among pts with CMV-D (80% vs. 15 %; p=<0.001). When compared to pts who were alive at 60 d, more pts who died had recurrent CMV infection, CMV-D, were in ICU at onset, high median peak of CMV-A, bacteremia, on steroids at diagnosis, and had antiviral-associated renal toxicity and myelotoxicity (all p<0.05). On MVA, predictors of 60 d mortality were recurrent CMV infection (OR 19.3, CI 4.7–78.7), CMV-D (OR 26.8, CI 5.7 –126.3), mechanical ventilation at onset of infection (OR 38.5, CI 2.7 – 536), and bacteremia (OR 6.6, CI 1.6–27.3) (all p<0.05).

Conclusion: Development of CMV-D (pneumonia) in pts with CLL is associated with steroids use and high mortality rate at 60 d. Future studies are needed for identification of CLL pts at high risk for CMV reactivation and whether antiviral prophylaxis is needed.

 


Subject Category: V. Virology including clinical and basic studies of viral infections, including hepatitis

Speakers:
Maria N. Chitasombat, MD , Infectious Department, University of Texas at Houston, Houston, TX
Ying Jiang, MS , Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Harrys Torres, MD , Infectious Department, University of Texas/MD Anderson Cancer Center, Houston, TX
Jeffrey J. Tarrand, M.D. , Department of Laboratory Medicine, University of Texas M. D. Anderson Cancer Center, Houston, TX
Khanh Nguyen, MD , Internal Medicine, University of Texas/MD Anderson Cancer Center, Houston, TX
Roy Chemaly, MD, MPH , Infectious Diseases, Infection Control and Employee Health, University of Texas - MD Anderson Cancer Center, Houston, TX

Disclosures:

M. N. Chitasombat, None

Y. Jiang, None

H. Torres, None

J. J. Tarrand, None

K. Nguyen, None

R. Chemaly, None

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