scholarly journals Post-transplant absolute lymphocyte count predicts early cytomegalovirus infection after heart transplantation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Minjae Yoon ◽  
Jaewon Oh ◽  
Kyeong-Hyeon Chun ◽  
Chan Joo Lee ◽  
Seok-Min Kang
Keyword(s):  
High Risk ◽  
Heart Transplantation ◽  
Immunosuppressive Therapy ◽  
Lymphocyte Count ◽  
Cytomegalovirus Infection ◽  
Absolute Lymphocyte Count ◽  
Cmv Infection ◽  
Igg Antibody ◽  
Post Transplant ◽  
The Relationship

AbstractImmunosuppressive therapy can decrease rejection episodes and increase the risk of severe and fatal infections in heart transplantation (HT) recipients. Immunosuppressive therapy can also decrease the absolute lymphocyte count (ALC), but the relationship between early post-transplant ALC and early cytomegalovirus (CMV) infection is largely unknown, especially in HT. We retrospectively analyzed 58 HT recipients who tested positive for CMV IgG antibody and received basiliximab induction therapy. We collected preoperative and 2-month postoperative data on ALC and CMV load. The CMV load > 1200 IU/mL was used as the cutoff value to define early CMV infection. Post-transplant lymphopenia was defined as an ALC of < 500 cells/μL at postoperative day (POD) #7. On POD #7, 29 (50.0%) patients had post-transplant lymphopenia and 29 (50.0%) patients did not. The incidence of CMV infection within 1 or 2 months of HT was higher in the post-transplant lymphopenia group than in the non-lymphopenia group (82.8% vs. 48.3%, P = 0.013; 89.7% vs. 65.5%, P = 0.028, respectively). ALC < 500 cells/μL on POD #7 was an independent risk factor for early CMV infection within 1 month of HT (odds ratio, 4.14; 95% confidence interval, 1.16–14.77; P = 0.029). A low ALC after HT was associated with a high risk of early CMV infection. Post-transplant ALC monitoring is simple and inexpensive and can help identify patients at high risk of early CMV infection.

scholarly journals 1075. Absolute Lymphocyte Count as a Predictor of Cytomegalovirus (CMV) Infection and Recurrence in Hematopoietic Stem Cell Transplant (HSCT) Recipients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S565-S565
Author(s):  
Joanne Reekie ◽  
Marie Helleberg ◽  
Christina Ekenberg ◽  
Mark P Khurana ◽  
Isabelle P Lodding ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Lymphocyte Count ◽  
Absolute Lymphocyte Count ◽  
Cell Transplant ◽  
Cmv Infection ◽  
Hematopoietic Stem ◽  
Host Disease ◽  
Graft Versus Host ◽  
Increased Risk ◽  
Acute Graft

Abstract Background Cytomegalovirus (CMV) is a serious complication following Hematopoietic Stem Cell Transplant (HSCT) and can lead to serious organ disease and mortality. This study aimed to investigate the association between absolute lymphocyte count (ALC) and CMV to determine whether ALC could help to identify those at an increased risk of CMV infection and recurrence Methods Adults undergoing HSCT between 2011 and 2016 at Rigshospitalet, Denmark were included. Cox proportional hazards models investigated risk factors, including ALC, for CMV infection in the first year post-transplant and recurrent CMV infection 6 months after clearance and stopping CMV treatment for the first infection. For the primary outcome ALC was investigated as a time-updated risk factor lagged by 7 days, and for recurrent CMV, ALC measured at the time at the time of stopping treatment for the first CMV infection was investigated (+/- 7 days). Results Of the 352 HSCT recipients included, 57% were male, 40% received myeloablative conditioning, 42% had high risk (D-R+) CMV IgG serostatus at transplant and the median age was 56 (IQR 43-63). 143 (40.6%) patients had an episode of CMV DNAemia a median of 47 days after transplant (IQR 35-62). A lower current ALC (≤ 0.3 x109/L) was associated with a higher risk of CMV infection in univariate analysis compared to a high current ALC (&gt; 1 x109/L). However, this association was attenuated after adjustment, particularly for acute graft versus host disease (Figure). 102 HSCT recipients were investigated for risk of recurrent CMV of which 41 (40.2%) had a recurrent CMV episode a median of 27 days (IQR 16-50) after stopping CMV treatment for the first infection. A lower ALC (≤ 0.3 x109/L) at the time of stopping CMV treatment was associated with a significantly higher risk of recurrent CMV after adjustment (Figure). A higher peak viral load (&gt; 1500 IU/ml) during the first episode of CMV infection was also associated with an increased risk of recurrent CMV (aHR 2.47, 95%CI 1.00-6.10 compared to &lt; 750 IU/ml). Association between absolute lymphocyte count (ALC) and risk of CMV infection and recurrent CMV within 6 months. **First CMV infection multivariable model also adjusted for sex, CMV serostatus, age, year of transplant, Charlson Comorbidity Index, Anti-thymocyte globulin (ATG) given, HLA donor-recipient matching, and acute graft versus host disease (time-updated) *Recurrent CMV infection multivariable model also adjusted for conditioning regimen, sex, CMV serostatus, age, year of transplant Anti-thymocyte globulin (ATG) given, HLA donor-recipient matching, and acute graft versus host disease and peak CMV viral load during the first CMV infection Conclusion A lower ALC at the time of stopping treatment for the first CMV infection was associated with an increased risk of recurrent CMV and could be used to help guide decisions for augmented CMV surveillance and clinical awareness of CMV disease symptoms in these patients. Disclosures All Authors: No reported disclosures

Post-Transplant Cyclophosphamide (PTCy) is Associated with Increased Cytomegalovirus Infection: A CIBMTR Analysis

Blood ◽  
2021 ◽  
Author(s):  
Scott R Goldsmith ◽  
Muhammad Bilal Abid ◽  
Jeffery J. Auletta ◽  
Asad Bashey ◽  
Amer Beitinjaneh ◽  
...  
Keyword(s):  
Cytomegalovirus Infection ◽  
Calcineurin Inhibitor ◽  
Chronic Gvhd ◽  
Infection Risk ◽  
Prevention Strategies ◽  
Cmv Infection ◽  
Post Transplant ◽  
Transplant Outcomes ◽  
Increased Risk

Prior studies suggest increased CMV infection following haploidentical donor transplantation with post-transplant cyclophosphamide (HaploCy). The role of allograft source and PTCy in CMV infection and disease is unclear. We analyzed the effect of graft source and PTCy on incidence of CMV infection as well as transplant outcomes as it relates to CMV serostatus and occurrence of CMV infection by d180. We examined patients reported to CIBMTR between 2012-2017 who had received HaploCy (n = 757), Sib with PTCy (SibCy, n=403), or Sib with calcineurin inhibitor-based prophylaxis (SibCNI, n=1605) for AML/ALL/MDS. Cumulative incidences of CMV infection by d180 were 42% (99% CI, 37-46), 37% (31 - 43), and 23% (20 - 26), respectively [p&lt;0.001]. CMV end-organ disease was statistically comparable. CMV infection risk was highest for CMV-Seropositive recipients (R+), but significantly higher in PTCy recipients regardless of donor [HaploCy (n=545): HR 50.3 (14.4 - 175.2); SibCy (n=279): HR 47.7 (13.3 - 171.4); SibCNI (n=1065): HR 24.4 (7.2 - 83.1); p&lt;0.001]. D+/R- patients also had increased risk for CMV infection. Among seropositive recipients or those developing CMV infection, HaploCy had worse OS and NRM. Relapse was unaffected by CMV infection or serostatus. PTCy was associated with lower chronic GVHD overall, but CMV infection in PTCy recipients was associated with higher cGVHD (p=0.006). PTCy, regardless of donor, is associated with higher incidence of CMV infection, augmenting the risk of seropositivity. Additionally CMV infection may negate the cGVHD protection of PTCy. This study supports aggressive prevention strategies in all patients receiving PTCy.

scholarly journals Absolute Lymphocyte Count As an Independent Prognostic Factor of IPI and NCCN-IPI in DLBCL Patients

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1636-1636 ◽  
Author(s):  
Kazuya Okada ◽  
Shinichi Ochi ◽  
Takashi Nagayama ◽  
Shogo Nabe ◽  
Kazuya Sakai ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
High Risk ◽  
Prognostic Factor ◽  
Lymphocyte Count ◽  
Blood Count ◽  
Absolute Lymphocyte Count ◽  
Independent Prognostic Factor ◽  
White Blood Count ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background: Previous studies have shown that the absolute lymphocyte count (ALC) in peripheral blood at diagnosis may be an independent prognostic factor of IPI for patients with diffuse large B-cell lymphoma (DLBCL). In the rituximab era, the U.S. National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) was developed to improve the risk stratification of DLBCL in comparison to the existing IPI. Therefore, the aim of this study was to clarify the impact of ALC at diagnosis on event free survival (EFS) and overall survival (OS) on analysis performed with factors included in NCCN-IPI. Patients and methods: We retrospectively reviewed the ALC of 413 patients with newly diagnosed DLBCL treated with R-CHOP at our hospital between January 2005 and March 2013. Primary central nervous system lymphoma patients were excluded from this study. ALC was determined in all patients from complete blood count with differential white blood count at the time of diagnosis, and prior to therapy administration. EFS and OS were estimated according to the Kaplan-Meier method. Multivariate analysis was performed with the proportional hazard Cox model. Results: The median ALC was 1.2x10E9/L (range, 0.06-9.0). We set an ALC cut-point at 1.0x10E9/L based on previous studies. The median follow-up duration was 40 months. Baseline characteristics according to ALC (<1.0x10E9/L[n=145] and >1.0x10E9/L[n=268]) are summarized in Table1. Patients with ALC<1.0x10E9/L had a significantly poorer EFS and OS than patients with ALC>1.0x10E9/L (5-year EFS, 37.0% versus 68.9%, p<0.001; 5-year OS, 46.3% versus 80.0%, p<0.001). On multivariate analysis performed with factors included in IPI and NCCN-IPI, ALC remained an independent predictor of EFS (IPI: hazard ratio [HR] 1.95; 95% confidence interval [CI] 1.43-2.68; p<0.001, NCCN-IPI: HR 1.94; 95%CI 1.42-2.65; p<0.001) and OS (IPI: HR 2.35; 95%CI 1.61-3.42; p<0.001, NCCN-IPI: HR 2.29; 95%CI 1.57-3.33; p<0.001) (Table2). Importantly, within the poor R-IPI group, ALC distinguished patients with different 5-year EFS (24.4% versus 50.4%, p<0.001) and OS (35.7% versus 65.7%, p<0.001). For the high NCCN-IPI group also, ALC distinguished patients with different 5-year EFS (14.8% versus 39.8%, p<0.01) and OS (17.5% versus 54.5%, p<0.001) (Figure1). Conclusions: According to our results, ALC<1.0x10E9/L is an adverse prognostic factor and independent of IPI and NCCN-IPI. ALC might be more successful in identifying high-risk patients in which IPI and NCCN-IPI analysis was unrevealing. Our results suggest that other therapeutic strategies may be more effective in high-risk patients with DLBCL. Disclosures No relevant conflicts of interest to declare.

scholarly journals THE INDIVIDUAL TAILORING OF IMMUNOSUPPRESSIVE THERAPY AFTER HEART TRANSPLANTATION

2018 ◽  
Vol 20 (1) ◽  
pp. 127-137
Author(s):  
N. N. Koloskova ◽  
V. N. Poptsov ◽  
A. О. Shevchenko
Keyword(s):  
Heart Transplantation ◽  
Immunosuppressive Therapy ◽  
Severe Heart Failure ◽  
Direct Effects ◽  
Transplant Recipients ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Post Transplant ◽  
The Individual

Heart transplantation is the «gold standard» of treatment severe heart failure. Immunosuppressive therapy aimed at the prevention of acute allograft rejection is the cornerstone of post-transplant management. In addition to its direct effects, immunosuppressive therapy is also involved in the generation of a number of post-transplant morbidities that limit the long-term outcome of heart transplant recipients. Given these data it appears that the individual tailoring of immunosuppressive therapy is of paramount importance in determining the outcome of heart transplantation. The goal of immunosuppressive therapy is to prevent rejection of the transplanted heart, while minimizing drug-related effects, such as infection, malignancy, diabetes, hypertension, and renal insuffi ciency. This review aimed is to analyze the protocols for the appointment of immunosuppressive therapy in various groups of recipients after heart transplantation.

scholarly journals Repeated CMV Infection in a Heart Transplantation Patient

2012 ◽  
Vol 2012 ◽  
pp. 1-5
Author(s):  
Josep Melero-Ferrer ◽  
Ignacio J. Sanchez-Lazaro ◽  
Amparo Navea-Tejerina ◽  
Luis Almenar-Bonet ◽  
Marino Blanes-Julia ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Heart Disease ◽  
High Risk ◽  
Ischemic Heart Disease ◽  
Heart Transplantation ◽  
Viral Infection ◽  
Antiviral Treatment ◽  
First Year ◽  
Cmv Infection ◽  
Transplantation Patient

Infections are one of the leading causes of morbidity and mortality in heart transplantation (HTx). Cytomegalovirus (CMV) is the most common viral infection during the first year after HTx, but it is more unusual after this time. We present the case of a patient who underwent an HTx due to a severe ischemic heart disease. Although the patient did not have a high risk for CMV, infection, he suffered a reactivation during the first year and then up to six more episodes, especially in his eyes. The patient received different treatments against CMV and the immunosuppression was changed several times. Finally, everolimus was introduced instead of cyclosporine, and mycophenolate mofetil was withdrawn. The presented case provides an example of how the immunosupresion plays a key role in some infections in spite of being a suitable antiviral treatment.

scholarly journals Day 100 Absolute Lymphocyte Count (ALC) Predicts Risk of Serious Infections in Lymphoma Patients Undergoing Autologous Hematopoietic Cell Transplantation (HCT)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3168-3168
Author(s):  
Arun Singavi ◽  
Jonathan Kapke ◽  
Adam Levin ◽  
Anjishnu Banerjee ◽  
Fenlu Zhu ◽  
...  
Keyword(s):  
T Cells ◽  
Cell Transplantation ◽  
Lymphocyte Count ◽  
Research Funding ◽  
Hematopoietic Cell Transplantation ◽  
Absolute Lymphocyte Count ◽  
Post Transplant ◽  
Transplant Patients ◽  
Serious Infections ◽  
Autologous Hematopoietic Cell Transplantation

Abstract Background: High-dose therapy with autologous hematopoietic cell transplantation (autoHCT) is now well established as an effective therapy for lymphoma. However, infection is a known risk of autoHCT. Following autoHCT, prolonged lymphopenia (PL) and hypogammaglobulinemia (HypoGG) can occur and lead to a significant acquired immunodeficiency. While early recovery of lymphocyte count has been found to be a predictor of overall survival post autoHCT, the risk factors for and effects of PL and HypoGG in this population have not been carefully studied. Methods: We retrospectively reviewed all lymphoma patients who received their first autoHCT at the Medical College of Wisconsin from January 2009-December 2013. Patient charts were abstracted for pre-transplant disease characteristics (including lines of chemotherapy and regimens received prior to HCT, rituximab use, absolute lymphocyte count (ALC) pre-HCT, CD34+ and lymphocytes infused with HCT product) and post-transplant outcomes including day 100 ALC, 1 year IgG/A/M levels, and serious infections (SI). SI was defined as bacteremia, pneumonia, meningitis, pneumonia, clostridium difficile, neutropenic fever; or any infection requiring admission; or 2 or more infections of any type. Primary outcomes of interest included whether SI correlated with Day 100 ALC and 1 year IgG/A/M levels. Survival outcomes (time to SI) were estimated using Kaplan Meier method, and comparisons made with Fisher's exact test, Chi-square tests, and log rank test. Multivariable analysis (MVA) was performed using the Cox proportional hazard regression. P-values of less than 0.05 were considered significant. Results: A total of 161 patients were included, of which 29 patients were excluded due to early relapse. Of the remaining 132 patients, 50 developed SI. Comparing the two groups (Table 1 - SI vs no SI), the majority of patients in both groups were Hodgkin Lymphoma, DLBCL, MCL, and FL with advanced stages at diagnosis. Prior to transplant, patients underwent >2 lines of chemotherapy and the majority were in complete remission at the time of transplant. Patients treated with HyperCVAD had a higher rate of SI (p<0.01) and ABVD had lower SI rate (p<0.01). 86 patients were treated with rituximab, with no difference in SI for total doses received or proximity to transplant. There was no association of ALC prior to transplant, CD34 infused, or lymphocytes infused with SI. Post-transplant, patients with low day 100 ALC (p=0.04) and low 1 year IgM (p<0.01) had significantly higher rates of SI. This difference was retained on multivariate analysis. Interestingly, IgG level at 1 year did not predict for SI. Conclusion: We conclude that, following autoHCT, lymphoma patients with a day 100 ALC < 1200 or 1 year IgM < 60 are at significantly higher risk for SI. Contrary to our original hypothesis, day 100 ALC didnot correlate with 1 year Ig G/A/M levels. Other cell types, such as helper T cells and regulatory T cells, may also contribute to effective reconstitution of humoral immunity, such that ALC alone may not be a reliable predictor of immunoglobulin recovery. Further prospective studies looking at subsets of lymphocytes, including B cells, T cell subsets, and NK cells may be helpful in identifying patients at significant risk for serious infections post autoHCT. Disclosures Hamadani: Celgene: Consultancy; Takeda: Research Funding; MedImmune: Consultancy; Cellerant: Consultancy. Hari:Janssen: Consultancy; Novartis: Consultancy; Spectrum: Consultancy; Sanofi: Consultancy; Takeda: Consultancy; Celgene: Consultancy; BMS: Consultancy. Fenske:Celgene: Honoraria; Seattle Genetics: Honoraria; Millennium/Takeda: Research Funding; Pharmacyclics: Honoraria.

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