Risk Factors and Clinical Features of Cytomegalovirus Disease in Children Receiving Anticancer Chemotherapy

Abstract

This study was conducted to identify risk factors for cytomegalovirus (CMV) infection and demonstrate the spectrum of CMV disease in children receiving anticancer chemotherapy without hematopoietic stem cell transplantation (HSCT). A total of 289 children who received chemotherapy and were tested for CMV infection were included in the study. CMV antigenemia and DNAemia were determined by identifying the pp65 antigen in leukocytes and performing real-time PCR. CMV disease was diagnosed by tissue biopsy, culture, or ophthalmic examination. Of the 289 children, CMV infection was demonstrated in 46 patients (15.9%). Young age at cancer diagnosis was the risk factor for CMV infection by multivariate analysis (7 mo vs. 7 y, P<0.001). Among 46 children with CMV infection, 10 (21.7%) were diagnosed with CMV disease; hepatitis (n=4), retinitis (n=3), hepatitis and pneumonia (n=2), and hepatitis and retinitis (n=1). The age of the patients with CMV disease was significantly younger than those without (3 vs. 16 mo, P=0.023). Retinoblastoma and neuroblastoma were the 2 most common underlying malignancies. There were 2 fatal cases associated with CMV disease, including 1 who died of CMV pneumonia. The findings of this study demonstrated significant morbidity of CMV infection and disease in young children during the course of chemotherapy without HSCT.

Unforeseen cytomegalovirus retinopathy following high dose thiotepa and proton irradiation in a pediatric patient with high-risk medulloblastoma: A case report

“…A high risk of risk of developing CMV disease among children with retinoblastoma undergoing chemotherapy was also documented in the study by Han and coworkers ( 11 ). Similarly, in young children with haemato-oncologic diseases receiving chemotherapy without hematopoietic stem cell transplantation, a significant morbidity of CMV infection was reported ( 26 ).…”

Cytomegalovirus Colitis in Immunocompetent and Immunocompromised Children

“…The diagnosis of CMV colitis was established in a median of 12 [IQR: [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] days after colonoscopy by H&E and/or IHC and positive tissue CMV PCR. This period was a median of 9 [IQR: [5][6][7][8][9][10][11][12][13][14] days in patients with a diagnosis of IBD. H&E alone and IHC alone were positive in 6 and 4 cases, respectively.…”

“…5 Furthermore, immunosuppressed subjects, including those with hematopoietic stem cell/ solid organ transplant, critically ill intensive care patients, and individuals using immunosuppressive therapies for inflammatory or malignant conditions, are under increased risk. [6][7][8][9][10] Among inflammatory bowel disease (IBD) cases, CMV colitis was reported predominantly in subjects with ulcerative colitis (UC) rather than Crohn's disease (CD). 11,12 CMV complicated acute UC flare was estimated as 10%.…”

“…5 Furthermore, immunosuppressed subjects, including those with hematopoietic stem cell/solid organ transplant, critically ill intensive care patients, and individuals using immunosuppressive therapies for inflammatory or malignant conditions, are under increased risk. 6–10…”

Half‐dose ganciclovir preemptive treatment of cytomegalovirus infection after pediatric allogeneic hematopoietic stem cell transplantation

“…One particular study of pediatric cancer patients with CMV disease furthermore cites a median initial CMV antigenemia titer of 29 cells/200,000 leukocytes, with peak antigenemia levels of <10/200,000 cells seen in only 1 of 10 patients . CMV viral load was also higher in patients displaying CMV disease than in those who did not.…”