233. The L-Index : Can It Predict CMV Reactivation Among Allogeneic Hematopoetic Stem Cell Transplant (HSCT) Recipients?
Session: Poster Abstract Session: Diagnostics: Use of Biomarkers
Thursday, October 27, 2016
Room: Poster Hall
  • L-index FInal.pdf (1.3 MB)
  • Background:

    Lymphocyte reconstitution helps prevent opportunistic infections after allogeneic hematopoietic stem cell transplantation (allo-HSCT).  We hypothesize that quantifying depth and duration of lymphopenia via the lymphocyte index (L-index) can help predict early CMV reactivation.



    We retrospectively reviewed 789 adults who underwent allogeneic HSCT at our institution from 1/1/2005 – 9/30/2015. The 714 patients included in this sub study were part of the D-index cohort (Figure 1). We obtained clinical data from the hospital transplant database and manual chart review from the date of transplant through Day 100.  The L-index was calculated as the area over the lymphocyte curve until engraftment, defined as lymphocyte count of 300 cells/µl.  CMV viremia and disease were defined using established criteria. 


    Subject characteristics are summarized in Table 1. Nearly one-third (207/714, 29%) developed either CMV viremia (181/207, 87%) or disease (26/207, 13%) at a median of 38 (0-98) days from time of transplant.  CMV disease was gastrointestinal (20/26, 77%), respiratory (4/26, 15%), or disseminated (2/26, 8%). Female gender and positive CMV recipient serostatus were associated with developing CMV reactivation.  Among 653 (91%) subjects in whom the measure was calculable, the median L index was similar for those with or without CMV (2477 vs 2425 days•lymphocyte/µl) (P=0.25).


    CMV reactivation is common among allo-HSCT in the early post-transplant period, occurring in 29% of our patients. The pre-engraftment L-index was similar in those with or without CMV reactivation and may not be useful to predict early post-transplant CMV reactivation among allo-HSCT recipients.

    Cybele Lara Abad, MD1, Brian Lahr, MS2, John C O'horo, MD1, R Walker, MD1, William Hogan, MD3 and Aaron Tande, MD1, (1)Division of Infectious Diseases, Mayo Clinic, Rochester, MN, (2)Biomedical Statistics and Informatics, Mayo Clinic, College of Medicine, Rochester, MN, (3)Department of Hematology, Mayo Clinic, Rochester, MN


    C. L. Abad, None

    B. Lahr, None

    J. C. O'horo, None

    R. Walker, None

    W. Hogan, None

    A. Tande, None

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