Epidemiology and outcome for viremia in children undergoing bone marrow transplant: A retrospective cohort study

Background Adenovirus can cause severe diseases in post‐hematopoietic stem cell transplant (HSCT) patients. Because these patients also have many other factors contributing to mortality, it remains controversial whether adenovirus infection itself contributes to increased mortality in these patients. Objective To determine if adenovirus infection contributes to mortality in pediatric post‐HSCT patients. Methods This retrospective cohort study was performed in post HSCT patients, aged 0–18 years old, admitted at Ramathibodi Hospital from 2016 to 2020. Adenovirus infection was defined as the detection of adenovirus in blood or urine by polymerase chain reaction. Multivariate cox regression was used to identify factors associated with death. Results The incidence of overall adenovirus infection (viremia or viruria) in this cohort was 20.8% (26 out of 125 enrolled patients). From the multivariate cox regression analysis, overall adenovirus infection was not significantly associated with death (hazard ratio [HR]: 2.41; 95% confidence interval [CI]: 0.96–6.06; p = .060). However, presence of viremia (HR: 3.90; 95% CI: 1.40–10.86; p = .009), having maximal serum viral load > 10 000 copies/ml (HR: 3.70; 95% CI: 1.20–11.38; p = .023), presence of end‐organ diseases (HR: 3.44; 95% CI: 1.18–10.01; p = .023) were associated with mortality. Underlying diseases requiring long‐term immunosuppressive drugs before HSCT, invasive fungal disease, invasive bacterial infection, cytomegalovirus infection, and longer engraftment time were also associated with mortality. Conclusion Overall adenovirus infection does not appear to play a significant role in mortality in pediatric post‐HSCT patients. However, more invasive forms of adenovirus infection were associated with mortality in these patients.

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“…Silcock et al. showed that death from virus‐associated causes was highest in patients with CMV infection (18.3%) 33 . Furthermore, McBride et al.…”

Section: Discussionmentioning

confidence: 99%

“…Silcock et al showed that death from virus-associated causes was highest in patients with CMV infection (18.3%). 33 Furthermore, McBride et al found that CMV viral load was associated with severe CMV disease and death. 34 Our results are in agreement with the findings from these studies.…”

Section: Discussionmentioning

confidence: 99%

Association between adenovirus infection and mortality outcome among pediatric patients after hematopoietic stem cell transplant

Wiriyachai

Chaya

Anurathapan

et al. 2021

Transplant Infectious Dis

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“…Children undergoing HSCT may experience either primary infection with CMV or reactivation of a latent infection. Recent studies estimate that CMV reactivation occurs in approximately 20% of HSCT recipients ( 14 , 15 ). It commonly presents asymptomatically and occurs an average of 8-weeks post-transplantation ( 8 , 16 , 17 ).…”

Section: Cytomegalovirus In Haematopoietic Stem Cell Transplantationmentioning

confidence: 99%

Cytomegalovirus in children undergoing haematopoietic stem cell transplantation: a diagnostic and therapeutic approach to antiviral resistance

et al. 2023

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Cytomegalovirus (CMV) is a ubiquitous virus which causes a mild illness in healthy individuals. In immunocompromised individuals, such as children receiving haematopoietic stem cell transplantation, CMV can reactivate, causing serious disease and increasing the risk of death. CMV can be effectively treated with antiviral drugs, but antiviral resistance is an increasingly common complication. Available therapies are associated with adverse effects such as bone marrow suppression and renal impairment, making the choice of appropriate treatment challenging. New agents are emerging and require evaluation in children to establish their role. This review will discuss established and emerging diagnostic tools and treatment options for CMV, including antiviral resistant CMV, in children undergoing haematopoietic stem cell transplant.

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“…Allogeneic hematopoetic stem cell transplantation (allo-HSCT) is one of the therapeutic options in pediatric acute lymphoblastic leukemia (ALL). Severe myelo-and lymphoablation, delayed immunoreconstitution, and the need for enhanced immunosuppression in the case of graft-versus-host disease (GvHD), all promote opportunistic infections, including viral infections [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Such complications result in longer immune recovery, intensive antiviral treatment, and longer hospitalization. Viremia post-HSCT is usually caused by virus reactivation of cytomegalovirus (CMV), Epstein-Bárr virus (EBV), adenovirus (ADV), BK Polyomavirus (BKV), herpes simplex virus-1, -2 (HSV-1, HSV-2), varicella zoster virus (VZV), and human herpes virus-6, -7 (HHV-6, HHV-7) [4,[6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Viral infections after hematopoetic stem cell transplantation in children with acute lymphoblastic leukemia: the Polish experience

Fałkowska,

Zaucha-Prażmo,

Drabko

et al. 2023

Acta Haematol Pol.

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Introduction: Allogeneic hematopoetic stem cell transplantation (allo-HSCT) is one of the therapeutic options in pediatric acute lymphoblastic leukemia (ALL). Most previous analyses have concerned the reactivation of viruses in the entire population of children after allo-HSCT, regardless of the disease entity being an indication for transplantation. In our report, we aimed to evaluate the occurrence, etiology, risk factors and clinical outcome of viral infections in pediatric patients with ALL.Material and methods: 83 post-HSCT ALL patients from 2020 through 2021 were analyzed for infections with polioma BK virus (BKV), cytomegalovirus (CMV), Epstein-Bárr virus, severe acute respiratory syndrome coronavirus 2, adenovirus, respiratory syncytial virus, norovirus, rotavirus, influenza, human herpes virus-6, parainfluenza and rhinovirus.Results: Viral infections were detected after 41% of the transplantations. The viruses most commonly detected were BKV (26.2%) and CMV (23.8%). The analyzed potential risk factors for viral infections were total body irradiation (TBI), graft-versus-host disease, complete remission status, and donor type. Overall survival in the investigated group was 0.815.

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Epidemiology and outcome for viremia in children undergoing bone marrow transplant: A retrospective cohort study

Cited by 5 publications

References 29 publications

Association between adenovirus infection and mortality outcome among pediatric patients after hematopoietic stem cell transplant

Association between adenovirus infection and mortality outcome among pediatric patients after hematopoietic stem cell transplant

Cytomegalovirus in children undergoing haematopoietic stem cell transplantation: a diagnostic and therapeutic approach to antiviral resistance

Viral infections after hematopoetic stem cell transplantation in children with acute lymphoblastic leukemia: the Polish experience

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