Risk factors and outcomes of cytomegalovirus viremia in pediatric hematopoietic stem cell transplantation patients

Wu, Jhong-Lin; Ma, Hsuan-Yin; Lu, Chi-Jen; Chen, Jong-Min; Lee, Ping–Ing; Jou, Shiann-Tarng; Yang, Yung-Lin; Chang, Hong-Yeh; Lu, Meng‐Yao; Chang, Luan-Ying; Huang, Li‐Min

doi:10.1016/j.jmii.2015.07.011

Cited by 33 publications

(42 citation statements)

References 26 publications

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“…A higher degree of immunosuppression might be the key factor for the increased CMV infection risk in haploidentical allo‐HSCT. Among the immunosuppressants administered to haploidentical recipients, ATG is highly related to CMV infection in allo‐HSCT . A comparable result was obtained in the univariate analysis in our study, but not in the multivariate analysis, which showed that ATG does not significantly increase the risk of CMV DNAemia (HR: 1.32; 95% CI: 0.50‐3.51; P = 0.571).…”

Section: Discussionsupporting

confidence: 81%

Haploidentical allogeneic hematopoietic stem cell transplantation increases the risk of cytomegalovirus infection in adult patients with acute leukemia

Lin

Hsu

et al. 2019

Transplant Infectious Dis

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Background:Owing to the shortage of hematopoietic stem cells from matched sibling donors (MSD) and matched unrelated donors (MUD), the number of patients undergoing haploidentical allogeneic hematopoietic stem cell transplantation (allo-HSCT) has rapidly increased. Despite a comparable overall survival (OS) and leukemia-free survival using this approach, some evidence suggests that haploidentical allo-HSCT recipients have a higher incidence of cytomegalovirus (CMV) infection, though this has not been clearly established. Methods:This study retrospectively compared the cumulative incidence of CMV DNAemia, 2-year OS, and leukemia-free survival rates in acute leukemia patients with MSD (n = 41), MUD (n = 18), and haploidentical donor allografts (n = 21). Results:The cumulative incidences of CMV DNAemia at day 180 in the MSD, MUD, and haploidentical groups were 39.0, 55.6, and 85.7%, respectively (P < 0.000). As less than 50% of patients in the MSD group were detected to have CMV DNAemia, the median time to CMV DNAemia detection in patients allografted with MSD could not be obtained. However, it was 42 and 29 days, respectively, for the MUD and haploidentical groups. Multivariate analysis revealed that haploidentical allo-HSCT (MSD vs. haploidentical: HR: 0.26; 95% CI: 0.09-0.78; P = 0.017) and age (HR: 1.03; 95% CI: 1.01-1.06; P = 0.011) increased CMV infection. Finally, MSD, MUD, and haploidentical allo-HSCT provided comparable 2-year OS rates (52.1%, 65.5%, and 65.6%; P = 0.425) and 2-year leukemia-free survival rates (67.1%, 68.3%, and 80.7%, P = 0.837). Conclusion:The CMV incidence was higher for haploidentical allo-HSCT than for MSD and MUD allo-HSCT; this could be explained by graft-versus-host disease prophylaxis by multiple immunosuppressants. K E Y W O R D Sallo-HSCT, haploidentical, cytomegalovirus, overall survival, leukemia-free survival

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Section: Discussionsupporting

confidence: 81%

Haploidentical allogeneic hematopoietic stem cell transplantation increases the risk of cytomegalovirus infection in adult patients with acute leukemia

Lin

Hsu

et al. 2019

Transplant Infectious Dis

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“…Viral infections are frequently encountered in pediatric patients undergoing hematopoietic stem cell transplant (HSCT) and are associated with significant morbidity and mortality. Clinical risk factors have been described during different periods post‐HSCT as contributing factors for the reactivation and/or primary acquisition of several viral infections among children . Viral reactivations in children are frequent especially following allogeneic transplantation (allo‐HSCT), while in autologous transplantation (auto‐HSCT) they have not been investigated in detail possibly due to the lack of routine surveillance.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of viral infections among children undergoing hematopoietic stem cell transplant: Α prospective single‐center study

Tsoumakas

Giamaiou

Goussetis

et al. 2019

Transplant Infectious Dis

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Background: Viral infections are a significant cause of morbidity and mortality in pediatric transplant populations. We analyzed the epidemiology of viral infections in pediatric hematopoietic stem cell transplant (HSCT) patients, including their incidence, associated risk factors, and outcome. Methods:In a prospective study from September 2011 to September 2015, blood, urine, and stool specimens were monitored weekly from transplantation to day 100 or after if clinically suspected, by use of real-time polymerase chain reaction. Cytomegalovirus (CMV), Epstein-Barr virus (EBV), BK polyomavirus (BKV), Herpes simplex virus-1,2, Varicella zoster virus, Human herpes virus-6,7, and Adenovirus infections were monitored. All children and adolescents who underwent HSCT received long-term follow up in the regular outpatient clinics (range 2-48 months). Results: A total of 192 HSCTs (autologous/allogeneic: 53/139) were performed in 165 subjects (median age: 5.6 years). Viruses most commonly isolated were CMV (46.1%), BKV (25.9%) and EBV (22.6%) and were more frequent in allogeneic versus autologous transplants (P < 0.05). Almost all high-risk allogeneic recipients developed EBV infections post-HSCT. EBV-PTLD was the only cause of death among those who developed viral disease. The factors significantly associated with the development of viral infections were recipient's advanced age, unrelated donor, mismatched graft and use of peripheral blood stem cells grafts. Conclusions: Viral infections were common among our pediatric recipients. Data suggest that monitoring of viral load may be significant to the prevention of viral disease. Particular demographic and transplantation characteristics were associated with the development of viral infections post-HSCT. K E Y W O R D S viral infections, hematopoietic stem cell transplant, risk factors, children

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“…Lilleri ve arkadaşları 178 allojenik HKHT alıcısında CMV viremisini %34, buna karşılık CMV antijenemisini %42 oranında daha yüksek tespit ederek kantitatif real-time PCR testinin uygulanmasının gereksiz antiviral tedaviyi önleyeceğini bildirmişlerdir [20] . Wu ve arkadaşları-nın çalışmasında HKHT uygulanan 57 çocuk hastadan %32 (18 hasta)'sinde CMV viremisi geliş-miştir ve bu olguların %89 (16/18)'unda ilk 100 günde infeksiyon ortaya çıkmıştır [21] . Hiwarkar ve arkadaşlarının araştırmasında allojenik HKHT yapılan 291 çocuk hastanın %16'sında CMV, %15'inde ADV ve %11'inde EBV infeksiyonu gelişmiştir [22] .…”

Section: Discussionunclassified

“…Çalışma grubumuzda miyeloablatif ve yoğunluğu azaltılmış hazırlama rejimi uygulanmış hastalarda CMV DNA (sırasıyla 32-8. Allojenik HKHT alıcısı 46 çocukta %26 oranında bulduğumuz CMV infeksiyonu insidansı Paris'in (%26.8) bulgusuna benzer, Hiwarkar (%16) ve Goldstein'in (%21) verilerinden biraz yüksek-tir, buna karşılık Gomes (%44), Lilleri (%34) ve Wu'nun (%32) bildirdiği oranlardan düşüktür [18][19][20][21][22][23] .…”

Section: Discussionunclassified

“…Goldstein ve arkadaşları da IVIG kullanan hastalarda CMV infeksiyonu insidansının daha düşük olduğunu gözlemişlerdir [19] . Wu ve arkadaşları ise CMV infeksiyonlarının %89'unun ilk 100 günde geliştiğini kaydetmiştir [21] . Çalış-mamızda ise bu oran %71.4 olarak daha düşük olup olguların %28.6'sının 100 gün sonrası tespit edilmesi profilaksinin uygulanmadığı geç dönemde de infeksiyonların arttığını göstermiştir ve bu sebeple olgular bir yıla kadar prospektif izlenmelidir.…”

Section: Discussionunclassified

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Investigation of Cytomegalovirus, Epstein-Barr Virus and Adenovirus Infections After Hematopoietic Stem Cell Transplantation (HSCT) in Pediatric Patients

Kaya¹,

Küpeli²,

Öztürk³

et al. 2018

FLORA

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ÖZET Giriş: Hematopoietik kök hücre transplantasyonu (HKHT) yapılan hastalarda immünsüpresif tedaviye bağlı viral infeksiyonlar özellikle sitomegalovirüs (CMV), Epstein-Barr virüs (EBV) ve adenovirüs (ADV) infeksiyonları morbidite ve mortalitenin başlıca sebebidir. Bu çalış-mada, HKHT yapılan çocuk hastalarda CMV, EBV ve ADV infeksiyonlarının insidansının araştırılması amaçlanmıştır. Materyal ve

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Risk factors and outcomes of cytomegalovirus viremia in pediatric hematopoietic stem cell transplantation patients

Abstract: In pediatric posttransplantation patients, CMV viremia mostly occurred within 100 days after transplantation. Risk factors associated with CMV viremia include older diagnostic age, leukemic patients, unrelated donor HSCT, pretransplant ATG use, GvHD, and gastrointestinal GvHD.

Cited by 33 publications

References 26 publications

Haploidentical allogeneic hematopoietic stem cell transplantation increases the risk of cytomegalovirus infection in adult patients with acute leukemia

Haploidentical allogeneic hematopoietic stem cell transplantation increases the risk of cytomegalovirus infection in adult patients with acute leukemia

Epidemiology of viral infections among children undergoing hematopoietic stem cell transplant: Α prospective single‐center study

Investigation of Cytomegalovirus, Epstein-Barr Virus and Adenovirus Infections After Hematopoietic Stem Cell Transplantation (HSCT) in Pediatric Patients

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