Absolute Lymphocyte Count (ALC) As A Prognostic Marker for Outcome in Hematological Malignancy Patients with Pulmonary Mucormycosis

Ref ID: 18785

Author:

R. E. Lewis, Pharm.D. – Professor1, F. Sampsonas, M.D. – Researcher 2, S. Georgiadou, M.D. – Fellow 2, G. Chamilos, M.D. – Fellow 3, D. P. Kontoyiannis, M.D. – Professor 2;

Author address:

1Univ. of Houston Coll. of Pharmacy, Houston, TX, 2The Univ. of Texas M.D. Anderson Cancer Ctr., Houston, TX, 3Univ. of Texas M.D. Anderson Cancer Ctr., Houston, TX.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: Pulmonary mucormycosis (PM) is a severe opportunistic mycosis that has variable clinical history and few prognostic markers for outcome assessment in hematology patients. Methods:Thirteen clinical risk factors encompassing immunosuppression (e.g., neutropenia, lymphocytopenia, steroids, etc.), metabolic derangement (hyperglycemia, acidosis, iron overload, etc.) and severity of clinical presentation (e.g, # pulm. nodules, dissemination, etc.) present at the diagnosis of PM (proven or probable, EORTC/MSG criteria) were screened for association with mortality by univariate analysis in 75 consecutive hematology patients from 2000-2011. Significant variables (P<0.05) were entered into a multivariate Cox-proportional hazard regression model to identify independent risk factors for patient mortality at 28 days. Results:When adjusted for time of initiation of a Mucorales-active antifungal, the probability of mortality at 28d was 3 or 4x higher in patients with a baseline ALC of 100-500 or < 100 vs. patients with an ALC greater than 500. A baseline ALC < 100 was more common in patients with uncontrolled malignancy and allogeneic HSCT (P=0.015), but was not exclusive to these populations. Conclusions: Severe lymphocytopenia at PM diagnosis is an important predictor of early death in hematology patients. Future clinical studies should consider ALC as a surrogate marker for severe immunosuppression and outcome stratification.

Abstract Number: M-1679

Conference Poster: y

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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