1552. Absolute Lymphocyte Threshold: A Simple Readily Available Tool to Predict Risk of Cytomegalovirus Infection after Transplantation
Session: Poster Abstract Session: Viruses and Bacteria in Immunocompromised Patients
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • Absolute Lymphocyte Threshold.pdf (607.9 kB)
  • Background: Cytomegalovirus (CMV) is a common infection after solid organ (SOT) and hematologic stem cell transplantation (HSCT). We correlated peripheral blood absolute lymphocyte count (PBALC) with risk of CMV infection in transplant patients.

    Methods: Thirty-six SOT and 28 HSCT consecutive patients with plasma CMV viral load (VL) testing for surveillance were enrolled. Clinical variables, including PBALC, were abstracted for correlation with CMV infection.

    Results: The median age was 54.5 years (IQR 40-63). Forty-three (67.2%) patients developed CMV infection (asymptomatic, 67.4%; CMV syndrome, 14%; gastrointestinal disease, 14%) at median of 4.4 months (IQR 1.4-7.7). Median VL was higher for symptomatic than asymptomatic infection (10,110 vs. 262 IU/mL, p = 0.006). PBALC <830 cells/mm3 correlated with CMV infection (sensitivity 95%; specificity 71%). Median PBALC among CMV infection patients was lower than those without infection (450 vs. 1,060 cells/mm3, p <0.0001). Among SOT patients, PBALC <610 cells/mm3 correlated with CMV infection (sensitivity 80%; specificity 73%); median PBALC was significantly lower among those who developed CMV infection (270 and 450 vs. 1120 cells/ mm3). Among HSCT recipients, PBALC <830 cells/mm3 correlated with CMV infection (sensitivity 100%; specificity 80%); median PBALC was lower among those who developed CMV infection (520 and 510 vs. 1,020 cells/ mm3) (Table 1).

    Conclusion: In the current era when sophisticated immunologic measures are being proposed as CMV prognosticator, we highlight the clinical importance of a simple readily-available PBALC.    

    Table 1. CMV VL and PBALC in patients with or without CMV infection.

    CMV disease

    Asymptomatic CMV viremia

    No CMV infection

    P value

    SOT, N = 36

    N = 7

    N = 18

    N = 11

    Median CMV VL (IQR) (IU/mL)

    32,500

     (352 - 118,000)

    423

    (297 - 6,315)

    0

    0.05*

    Median PBALC

    (IQR) (cells/mm3)

    270

    (140 - 460)

    450

    (388 - 675)

    1,120

    (590 - 1,400)

    0.001

    HSCT, N = 28

    N = 3

    N = 15

    N = 10

    Median CMV VL (IQR) (IU/mL)

    1,220

    (426 - 2,520)

    884

    (347 - 1,980)

    0

    0.62*

    Median PBALC

    (IQR) (cells/mm3)

    520

    (300 - 560)

    510

    (330 - 670)

    1,020

    (795 - 3,308)

    0.03

    PBALC: peripheral blood absolute lymphocyte count; CMV: cytomegalovirus; HSCT: hematologic stem cell transplantation; IQR: interquartile range; SOT: solid organ transplantation; VL: viral load

    *Comparison between CMV disease and CMV viremia recipients

    Atibordee Meesing, MD, Medicine, Division of Infectious Disease and Tropical Medicine, Faculty of Medicine, Khon Kaen University, Khonkaen, Thailand, Joseph Yao, MD, FIDSA, Mayo Clinic, Rochester, MN and Raymund R. Razonable, MD, FIDSA, Division of Infectious Diseases, Mayo Clinic, Rochester, MN

    Disclosures:

    A. Meesing, None

    J. Yao, None

    R. R. Razonable, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.