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 dayslymphocyte/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.
C. L. Abad,
J. C. O'horo, None
R. Walker, None
W. Hogan, None
A. Tande, None