The impact of alternative donor types on viral infections in pediatric hematopoietic stem cell transplantation

Abstract

Viral infections remain one of the most important complications following allogeneic HSCT. Few reports compare virus infection between different donor types in pediatric patients. We retrospectively analyzed viral infections and the outcome of one hundred and seventy-one pediatric patients (median 7.38 years) who underwent allogeneic HSCT from matched related donor (MRD, n = 71), 10 of 10 HLA allele-matched unrelated donors (MUD1; n = 29), 9 of 10 HLA allele-matched unrelated donors (MUD2; n = 40), and haploidentical donors (n = 31). PCR screening for BK virus, adenovirus, Epstein-Barr virus, parvovirus B19, human herpesvirus 6, and CMV were performed routinely weekly. Infections between 0-30, 31-100, and 101 days-2 years were identified separately. BK virus and CMV reactivations were significantly low in MRD transplant patients (P = .046 and P < .0001, respectively), but incidences of all virus infections between MUD1, MUD2, and haplo-HSCT were found statistically not different. The OS was found to be affected by having one or multiple virus infection (P = .04 and P = .0008). Despite antiviral prophylaxis and treatments, post-transplant viral infections are associated with reduced overall survival. Haplo-HSCT is comparable with MUD transplantation in the setting of viral infections. A larger study group and prospective studies are needed to confirm this observation.

Cytomegalovirus Infection Incidence and Risk Factors Across Diverse Hematopoietic Cell Transplantation Platforms Using a Standardized Monitoring and Treatment Approach: A Comprehensive Evaluation from a Single Institution

“…Although the level of detail available to investigate CMV infection and risk modifiers exceeds a registry-based approach, our study is limited by the fact that the variables evaluated across the HCT approaches investigated herein such as disease type, graft source, and T cell manipulation strategy were determined in aggregate by protocol design and not as independent variables. The degree of HLA matching and donor relatedness are known determinants of CMV infection among at-risk recipients [14], although it is difficult to separate the GVHD prophylaxis approach and the risk for developing GVHD determined by HLA match from differences in post-HCT CMV-specific immunity related directly to the degree of HLA matching. Among recipients of haplo grafts, others have shown that in vivo TCD with antithymocyte globulin carries higher rates of CMV infection and viral infectionÀrelated mortality when compared with PTCy-based approaches to haplo HCT [15].…”

“…Given that HLA mismatching has been associated with increased risk of CMV infection and that a recipient may often have multiple haplo donor options of different CMV serostatuses [14,15], we specifically evaluated the CInc of CMV infection among PTCy-treated HCT recipients, because recipients of haplo grafts (excluding haplo-UCB) all received PTCy. Among PTCy-treated recipients an identical multiple logistic regression analysis was run.…”

Delaying haematopoietic stem cell transplantation in children with viral respiratory infections reduces transplant‐related mortality

“…Haematopoietic stem cell transplantation (HSCT) is curative for several haematological (Peters et al, 2010) and immunological disorders (Freeman, 2018), as well as an alternative approach to enzyme replacement therapy in some inborn errors of metabolism (de Ru et al, 2011). However, infections are a major cause of treatment failure and contribute significantly to transplant-related mortality (TRM) (Atay et al, 2018). Viral infections are difficult to control in immunocompromised hosts, such as transplanted patients, due to impaired humoral and cell-mediated immunity post-HSCT because of in vivo (serotherapy) (Lamba et al, 2005) or ex vivo (alpha/beta and B cells depletion) lymphodepletion (Laberko et al, 2017) and immunosuppressants used to treat graft-versus-host disease (GvHD).…”

Factors Associated with Post-Transplant Active Epstein-Barr Virus Infection and Lymphoproliferative Disease in Hematopoietic Stem Cell Transplant Recipients: A Systematic Review and Meta-Analysis

“…In total, 3362 titles were identified in the research bases, 1883 in EMBASE and 1479 in Medline. Once duplicates and papers with exclusion criteria were removed, 77 articles [ 4 , 16 , 23 , 24 , 27 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 ,…”