1002. Paradoxical Increasing Cytomegalovirus Antigenemia Titer during Preemptive Ganciclovir Therapy in Hematopoietic Stem Cell Transplant Recipients: Incidence, Risk Factors, and Clinical Outcomes
Session: Poster Abstract Session: CMV and Transplantation
Saturday, October 22, 2011
Room: Poster Hall B1
Background: There are occasional cases which reveal increasing cytomegalovirus (CMV) antigenemia titer during preemptive therapy in patients with hematopoietic stem cell transplantation (HCT). We thus determined the incidence, risk factors, and clinical outcomes of paradoxical responders (PR) during ganciclovir (GCV) preemptive therapy.

Methods: All adult patients undergoing allogeneic HCT were enrolled and prospectively monitored for antigenemia once a week until 6 months after engraftment. PR were defined as patients exhibited the elevation of antigenemia level from baseline after the first week of preemptive therapy.

Results: Finally, 97 (38%) who received preemptive therapy were analyzed and 23 (25%, 95% CI 16%-34%) were classified as PR. Risk factors for them were low WBC count (P=0.02) and prolonged duration of antigenemia before preemptive therapy (P=0.04). While there were no differences in successful viral clearance (P=0.35) and secondary episode of CMV infection (P=0.78), CMV diseases during preemptive therapy were significantly higher in PR (17% [4/23]) than in non-PR (3% [2/74], P=0.03). The detailed data are shown in Table.

Conclusion: Paradoxical response occurred in about one fourth of HCT recipients receiving preemptive GCV therapy. Breakthrough CMV disease during preemptive therapy more frequently occurred in these paradoxical responders.

Table Baseline characteristics and outcomes

 

PR

(n=23 )

Non-PR

(n=74 )

P value

Age, median years (range)

47 (20-63)

42 (16-70)

0.7

Male gender

11 (48)

46 (62)

0.22

WBC count before treatment (/mm3), mean (± SD)

3178 ± 2889

4493 ± 3214

0.02

Baseline levels of antigenemia, mean (± SD)

128 ± 327

184 ± 487

0.96

Days of antigenemia positivity prior to GCV therapy, mean (± SD)

7.6 ± 7.3

4.7 ± 7.2

0.04

GVHD during first 100 days

10 (44)

36 (49)

0.66

Total duration of GCV use, mean days (± SD)

20.0 ± 36.3

15.8 ± 9.5

0.36

Total duration of antigenemia clearance, mean days (± SD)

23.4 ± 10.3

13.9 ± 7.6

<0.001

Successful viral clearance

20 (87)

70 (95)

0.35

Secondary episode of CMV infection

6 (26)

17 (23)

0.78

CMV disease

4 (17)

2 (3)

0.03

Pneumonia

0

1

 

Gastroenteritis

2

1

 

CMV syndrome

2

0

 

Overall mortality

8 (35)

29 (39)

0.7

NOTE: Data are presented as no. (%) of patients unless otherwise indicated.


Subject Category: O. Transplant infectious diseases

So-Youn Park, MD1, Song Mi Moon, MD1, Hyun Jung Park, MD1, Sang-Oh Lee, MD1, Sang-Ho Choi, MD, PhD1, Yang Soo Kim, MD, PhD1, Jun Hee Woo, MD, PhD1, Heungsup Sung, MD, PhD2, Mi-Na Kim, MD, PhD2, Dae-Young Kim, MD3, Jung-Hee Lee, MD, PhD3, Je-Hwan Lee, MD, PhD3, Kyoo-Hyung Lee, MD, PhD3 and Sung-Han Kim, MD, PhD1, (1)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, (2)Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, (3)Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Disclosures:

S. Y. Park, None

S. M. Moon, None

H. J. Park, None

S. O. Lee, None

S. H. Choi, None

Y. S. Kim, None

J. H. Woo, None

H. Sung, None

M. N. Kim, None

D. Y. Kim, None

J. H. Lee, None

J. H. Lee, None

K. H. Lee, None

S. H. Kim, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.