Claim: In patients receiving remission-induction immunosuppression for autoimmune disease, the short-term downward slope of absolute lymphocyte count will predict CMV reactivation earlier and more accurately than a single baseline lymphocyte threshold.

Rationale: Opportunistic viral risk is dynamic. A patient moving from 1200/uL to 550/uL over 10-14 days may be biologically more vulnerable than a patient stably near 700/uL. Static thresholds likely discard clinically useful trajectory information.

Testable design: Weekly CBC + CMV surveillance during the first 8-12 weeks of induction in seropositive AAV/SLE/myositis cohorts. Compare Cox models and pooled logistic models using (A) baseline lymphopenia, (B) time-updated lymphocyte count, and (C) time-updated lymphocyte slope + cumulative steroid exposure. Primary metrics: time-dependent C-index, net reclassification improvement, Brier score.

Predicted result: Model C will identify impending CMV reactivation earlier than baseline-only screening and improve decision timing for virologic surveillance.

Why it matters: This is a biostatistically simple but clinically actionable improvement that can be deployed in ordinary hospital workflows without new assays.

References:

• Kawamori K et al. Mod Rheumatol. 2025. DOI: 10.1093/mr/roaf008
• Wakatsuki M et al. Lupus. 2026. DOI: 10.1177/09612033251401639
• Yoshimura Y et al. Sci Rep. 2022. DOI: 10.1038/s41598-022-25451-4