1538. High Mortality of Cytomegalovirus (CMV) Pneumonia in Hematopietic Cell Transplant Recipients

BACKGROUND: CMV infection remains a leading cause of morbidity and mortality in allogeneic hematopoietic cell transplant (allo-HCT) recipients. CMV can cause tissue-invasive disease, especially pneumonitis, with poor outcomes. METHODS: We performed a retrospective study in HCT recipients who had CMV pneumonia between January 2014 and December 2017. The microbiology laboratory records were queried to identify patients with CMV pneumonia based on CMV viral culture and CMV viral load (VL) in plasma and in bronchoalveolar lavage (BAL). Data on demographics, clinical characteristics, management and mortality were collected. RESULTS: A total of 23 patients were diagnosed with CMV pneumonia and nine (39%) were male, with a median age of 59 years (range 18–83), and median time from HCT to CMV pneumonia of 104 days (range 25–1,177). Most patients had an allo-HCT (20, 87%) and three (13%) had an autologous HCT. All patients except one were CMV seropositive, 13 (57%) were on steroids and eight (42%) had GVHD. The median plasma CMV VL at diagnosis was 137 UI/mL (range: 0–6,586) while the median VL in BAL was 1,700 UI/mL (range 79–64,800) (Figure 1). Foscarnet was the most common antiviral agent used (12, 52%) followed by ganciclovir (7, 30.4%). Seventeen (81%) patients received combination therapy with IVIGs with a mean number of doses of 4 (range, 1–7). All-cause mortality was 87% and CMV-associated mortality was 52%. The median VL in BAL in patients with CMV-associated mortality was higher (12,340 vs. 2,863 IU/mL, P = 0.059) than the remaining cohort. CONCLUSION: CMV pneumonia remains a significant cause of mortality after HCT. The correlation between CMV VL in BAL and plasma was poor. High CMV VL in BAL was associated with fatal outcome. [Image: see text] DISCLOSURES: All authors: No reported disclosures.