2298. The ability of CMV–specific ELISPOT assay to predict outcome of low level CMV reactivation in hematopoietic cell transplant recipients
Session: Poster Abstract Session: Transplants: CMV and Transplantation
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • IDSA Poster - Low CMV (final).pdf (849.3 kB)
  • Background: CMV infection causes significant morbidity and mortality after allogeneic hematopoietic cell transplantation (allo-HCT). CMV cell mediated immunity, as assessed by T cells production of interferon gamma (IFN-γ) and other cytokines, is considered as a major pathway to control CMV replication. We aimed to evaluate the ability of a CMV-specific ELISPOT assay to predict the outcome of low-level CMV reactivation in allo-HCT recipients.

    Methods: In this prospective observational study, we enrolled allo-HCT recipients with low level of CMV viral loads (VL) <1000 IU/ml or <500 IU/ml if they had graft-versus-host disease or were receiving systemic corticosteroids. Patients were serially monitored with a CMV-specific ELISPOT assay (T-SPOT®.CMV, Oxford Diagnostics Laboratories®, Memphis, TN) on a weekly basis and up to 8 weeks from the date of first CMV reactivation. Progression from low level reactivation was defined as either ≥50% increase in CMV VL and/or CMV end-organ disease. Data from 25 patients who reached 4 weeks of follow-up were analyzed.

    Results: Majority of the patients were white (43%), males (70%), with a median age of 58 (18 – 68) years, and had unrelated (52%) or matched related (30%) HCT. Progression of CMV infection occurred in 12 (52%) allo-HCT recipients. We observed an inverse correlation of peak CMV VL with CMV specific pp65 spot counts (SPC) (Coefficient= -0.44, P = 0.01). Mean (±SD) pp65 SPC was significantly lower in patients who progressed from low level CMV reactivation when compared to patients who did not (10 (± 20) vs. 183 (± 138) SPC; P= 0.0003, respectively). The risk of CMV progression was 52% for a decline of 10 pp65 SPC by next time point of measurement (OR= 1.52 (1.04 – 2.21), P = 0.029).

    Conclusion: Preliminary analyses showed an association between low CMV-specific T cell responses and progression of CMV infection in allo-HCT recipients. Serial monitoring of anti-CMV immune response may help stratify allo-HCT recipients at risk of progression from low CMV VL to significant CMV infection, but needs further validation.

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    Dimpy Shah, MD, MSPH, PhD1, Ella Ariza-Heredia, MD2, Firas El Chaer, MD3, Lynn El Haddad, PhD4, Danielle El-Haddad, MD1, Amrita Prayag, M.B.B.S., MS5, Lior Nesher, MD6, Katy Rezvani, MD, PhD7, Elizabeth Shpall, MD7 and Roy F. Chemaly, MD, MPH, FIDSA, FACP2, (1)Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX, (2)Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX, (3)Infectious Diseases, Baylor College of Medicine, Houston, TX, (4)The University of Texas MD Anderson Cancer Center, Houston, TX, (5)Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, TX, (6)Infectious Disease Institute, Soroka University Medical Center, Beer Sheba, Israel, (7)Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX

    Disclosures:

    D. Shah, None

    E. Ariza-Heredia, Oxford Immunotec: Grant Investigator , Research grant

    F. El Chaer, None

    L. El Haddad, None

    D. El-Haddad, None

    A. Prayag, None

    L. Nesher, None

    K. Rezvani, None

    E. Shpall, None

    R. F. Chemaly, Oxford Immunotec: Consultant , Grant Investigator and Investigator , Consulting fee , Research support and Speaker honorarium

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.