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Lymphocytopenia as an unfavorable prognostic factor in patients with
cytomegalovirus infection after bone marrow transplantation
H Einsele, G Ehninger, M Steidle, I Fischer, S Bihler, F Gerneth, A Vallbracht, H Schmidt, HD Waller and CA Muller
Medizinische Klinik und Poliklinik, Abteilung II, Tubingen, Germany.
Sixty-three recipients of an allogeneic marrow transplant were screened for
the occurrence of cytomegalovirus (CMV) infection and clinical parameters
possibly predicting the development of CMV disease in a retrospective
study. Blood and urine samples obtained from these patients were screened
weekly after bone marrow transplantation (BMT) for the presence of CMV by
polymerase chain reaction (PCR) and virus culture technique. Forty-six of
the 63 patients studied were found to be CMV-positive by PCR technique in
blood and urine samples at a median of 29 days after BMT. In 33 of these 46
patients, CMV could be cultured from urine samples and 16 of the 46 had
culture-positive viremia. Twenty-eight of these 46 PCR-positive patients
developed CMV disease. Whereas PCR assays showed an optimal negative
predictive value and sensitivity for the development of CMV disease, their
positive predictive value was 61% and could not be remarkably increased
when culture-proven viruria (64%) and viremia (69%) were considered. Acute
graft-versus-host disease (GVHD) grade 2 to 4 (P < .05), but not
underlying disease, conditioning therapy, or GVHD prophylaxis, was
associated with CMV infection. On day +49, a remarkable decrease (P <
.001) in the lymphocyte count, as well as in the absolute number of CD4+,
CD8+, and CD56+ lymphocytes, occurred only among the patients who later
developed CMV disease. The decrease of all of these cell counts, but
predominantly the CD4+ T cells, to less than 100/microL on day +49 after
BMT showed a very high positive predictive value (100%) for the development
of CMV disease in patients with PCR-proven viremia. Persisting CD4
lymphopenia after antiviral therapy was only observed in patients who
finally died of CMV disease. Thus, immunophenotyping of the patients after
BMT in addition to a highly sensitive virus detection assay might help to
identify patients at high risk to develop CMV disease and indicate the need
for additional adoptive immunotherapy.
Volume 82,
Issue 5,
pp. 1672-1678,
09/01/1993
Copyright © 1993 by The American Society of Hematology
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