Methods: A cross-sectional study involving 50 pediatric leukemic patients receiving chemotherapy at Ramathibodi Hospital, Bangkok, Thailand from December 2015 to December 2016 was performed. Plasma CMV viral load quantified by the Abbott RealTime CMV assay (Abbott Molecular Inc., Des Plaines, IL, USA) was monitored in different phases of chemotherapy; post-induction, post-consolidation, post-intensification, and maintenance.
Results: Of 50 patients enrolled, 141 blood tests were evaluated. The overall prevalence of CMV DNAemia (≥ 31.2 IU/ml) and high-level CMV DNAemia (≥ 1,500 IU/ml) were 52.0% (26 of 50) and 16.0% (8 of 50), respectively. All patients with high-level CMV DNAemia were in maintenance phase of chemotherapy. One patient had CMV retinitis, while the rest had no end organ diseases. Lymphocyte count increase was significantly associated with protection from high-level CMV DNAemia, odds ratio 0.997, P = 0.02. The ROC curve analysis identified a cut-off value of 798 /μL of absolute lymphocyte count (ALC) as a discriminator for the presence of high-level CMV DNAemia, AUC 0.756, 95% CI 0.645-0.867, P = 0.001, with 88.9% sensitivity and 50.4% specificity.
Conclusion: In pediatric leukemia, non-transplant setting, CMV infection predominantly occurred during maintenance phase of chemotherapy. Lower ALC was significantly associated with high-level CMV DNAemia. We recommend that CMV infection surveillance by a quantitative CMV DNA PCR be considered during maintenance phase in pediatric leukemic patients with ALC < 800 /𝜇L.
C. Techaseansiri, None
U. Anurathapan, None