Surveillance of cytomegalovirus (CMV) DNAemia in pediatric allogeneic stem cell transplantation: incidence and outcome of CMV infection and disease

Abstract

Cytomegalovirus (CMV) remains a serious problem after hematopoietic stem cell transplantation (HSCT). To investigate the incidence of CMV infection and outcome we retrospectively analyzed 70 consecutive pediatric allogeneic HSCTs monitored by CMV polymerase chain reaction (PCR), with at least 1-year follow-up or until death. All patients at risk for CMV infection (CMV-seropositive patients and CMV-seronegative recipients transplanted from CMV-seropositive donors) received hyperimmune anti-CMV globulins whereas in the group of HSCT patients with both donor and recipient CMV negativity, polyvalent immunoglobulins were given, both at a dose of 400 mg/kg. All patients received acyclovir at prophylactic doses for at least 6 months. Patients were monitored twice a week by CMV PCR. Patients with 2 positive results for CMV DNAemia received ganciclovir for 14 days and continued until 2 consecutive negative results were obtained. The incidence of CMV DNAemia was 12.8% (9/70) in the whole group, with significant higher risk for patients with CMV-seropositive recipient status, 8 out of 22 (36%), vs. patients with seronegative status, 1 out of 48 (2%) (P=0.0002). Three out of 9 patients with DNAemia developed CMV disease despite adequate preemptive treatment. The transplant-related mortality was higher in the CMV-seropositive recipient group (P=0.05). Age, use of hyperimmune anti-CMV globulins at a high dose, and the low incidence of graft-versus-host disease might be contributing factors to this low incidence.

Diagnostic Utility of Human Cytomegalovirus-Specific T-Cell Response Monitoring in Predicting Viremia in Pediatric Allogeneic Stem-Cell Transplant Patients

“…CMV infection was defined as any asymptomatic increase of CMV viral load more than or equal to 1000 genomic copies/mL of blood and this threshold was used to start the preemptive therapy (49,50). CMV disease was defined according to published criteria (51).…”

Observational prospective study of viral infections in children undergoing allogeneic hematopoietic cell transplantation: a 3-year GETMON experience

“…4,19,20 Concerning risk factors that can potentially increase the likelihood to develop viral infections, we found recipient serostatus to be the dominant risk factor for CMV infection, according to other published series. 21,22 Morbidity related to a high incidence of infections has been one of the limitations to the use of cord blood as source of cells. Benjamin et al, 23 in a retrospective study including 485 children, observed that after 30 days from TPH, children who received unrelated cord blood and matched unrelated donor transplantation were at much higher risk of infection than were patients who received matched sibling or haploidentical transplantation; specifically with regard to viruses, patients who received unrelated cord blood or unrelated donor were at higher risk of ADV but not CMV.…”

Cytomegalovirus in Hematopoietic Stem Cell Transplant Recipients

“…64 Although a CMV-seropositive recipient is at higher risk for transplant-related mortality than a seronegative recipient, 65,66 the impact of donor serostatus on nonrelapse mortality and survival when the recipient is seropositive remains controversial. [67][68][69][70][71][72][73][74][75][76][77][78] This combination, however, has been reported as a risk factor for delayed CMV-specific immune reconstitution, [79][80][81][82] repeated CMV reactivations, 80,83 late CMV recurrence, 84 and development of CMV disease. 46,80,85 Other risk factors for CMV infection after allogeneic HSCT include the use of high-dose corticosteroids, T-cell depletion, acute and chronic GVHD, and the use of mismatched or unrelated donors.…”