935. Risk factor for Cytomegalovirus infection in Patients with Chronic Lymphocytic Leukemia: Case control study
Session: Poster Abstract Session: Biomarkers and Risk Factors for Viral Infections
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Patients (pts) with chronic lymphocytic leukemia (CLL) receiving T cell depleting agents are at risk of developing CMV infection. CMV infection may result in significant morbidity & mortality among leukemic pts. Data on risk factors and outcome are lacking.

Methods: We reviewed a database of pts with CLL between January 1998 and December 2009 with a total of 1862 pts. We identified 136 pts with CMV infection and 100 out 343 pts without CMV infection but positive CMV serology and matched by age, gender and year of treatment with same year of CMV diagnosis to determine predictors of CMV infection.

Results: Incidence of CMV infection in pts with CLL over 13 y. was 7.3% (136/1862). CMV infection and/or disease occurred in 115 pts (85%) and 21 pts (15%), respectively. Median age was 64 y (39-84y) and majority were males (63 %) and caucasian (92%). When compared to cases, more controls were on CMV prophylaxis (5% vs. 1%; p=0.086), in remission(38% vs. 17%; p=<0.001), received rituximab (77% vs. 58%; p=0.003), had concomitant viral infection other than CMV (24% vs. 12%; p = 0.022) and had bacterial pneumonia (33% vs. 14%; p<0.001). More cases received alemtuzumab than controls (52% vs. 27%; p<0.001). Multivariate analysis (MVA) identified alemtuzumab based therapy as a predictor of CMV infection (OR 2.6, CI: 1.4-4.8); while remission status of CLL (OR 0.3, CI: 0.2-0.7), and rituximab based therapy (OR 0.4, CI: 0.2-0.8) were protective factors; (all p<0.05). Mortality at 90 days of pts with CMV infection was 18%. In addition, on MVA, pts who died with CMV infection were more likely to have multiple episode of CMV reactivation, higher peak of CMV antigenemia, being on mechanical ventilation and having bacteremia (all p<0.05).

Conclusion: CMV infection remains a significant cause of morbidity and mortality among CLL pts. Alemtuzumab based therapy increased the risk of CMV reactivation. CMV monitoring in high risk CLL pts is recommended for early detection and possible prevention of CMV disease.


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

Maria N. Chitasombat, MD, Infectious Department, The University of Texas Health Science Center at Houston , Houston, TX, Yin Jiang, The University of Texas, M.D. Anderson Cancer Center Houston, Texas , Houston, TX, Harrys A. Torres, MD, Infectious Department, University of Texas/MD Anderson Cancer Center, Houston, TX, Jeffrey Tarrand, MD, M D Anderson Cancer Center, Houston, TX, Khanh Nguyen, MD, General Internal Medicine, The University of Texas, M.D. Anderson Cancer Center, houston, TX, Khan Vu, MD, General internal medicine, The University of Texas, M.D. Anderson Cancer Center, houston, TX, Susan Lerner, The University of Texas, M.D. Anderson Cancer Center, houston, TX, Michael Keating, MD, Leukemia, The University of Texas, M.D. Anderson Cancer Center, houston, TX and 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. A. Torres, None

J. Tarrand, None

K. Nguyen, None

K. Vu, None

S. Lerner, None

M. Keating, None

R. Chemaly, chimerix: Investigator, Research grant
aicuris: Investigator, Research grant

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.