Features of cytomegalovirus infection and evaluation of cytomegalovirus-specific T cells therapy in children’s patients following allogeneic hematopoietic stem cell transplantation: A retrospective single-center study

Abstract

Cytomegalovirus (CMV) infection remains a critical cause of mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT), despite improvement by pre-emptive antivirus treatment. CMV-specific cytotoxic T lymphocytes (CMV-CTL) are universally used and proven well-tolerance after allo-HSCT in adult clinical trials. However, it is not comprehensively evaluated in children’s patients. Herein, we conducted a retrospective study to determine the risk factors of CMV infection and evaluation of CMV-CTL in children patients who underwent allo-HSCT. As result, a significantly poor 5-year overall survival was found in the CMV infection group (87.3 vs. 94.6%, p=0.01). Haploidentical HSCT (haplo-HSCT) was identified as an independent risk factor for CMV infection through both univariate and multivariate analyses (p<0.001, p=0.027, respectively). Furthermore, the cumulative incidence of CMV infection was statistically higher in the haplo-HSCT group compared to the HLA-matched donor group (44.2% vs. 21.6%, p<0.001). Finally, the overall response rate of CMV-CTL was 89.7% (26/29 patients) in CMV infection after allo-HSCT. We concluded that CMV infection following allo-HSCT correlated with increased mortality in children’s patients, and haplo-HSCT was an independent risk factor for CMV infection. Adoptive CMV-CTL cell therapy was safe and effective in pediatric patients with CMV infection.

Refractory human cytomegalovirus infection without evidence of genetic resistance in the UL-54 and UL-97 genes in a pediatric hematopoietic stem cell transplant recipient: a case report

“…The therapy is suggested for cases of refractory CMV with progressive viral disease such as pneumonitis and colitis (18). Donor-derived CMV-TCT has been proven to be effective in treating CMV infections in pediatric patients undergoing HSCT, with an overall response rate of 89.5% (19). Combining CMV-TCT with foscarnet has demonstrated efficacy in resolving CMV-associated retinitis in a pediatric recipient of haploidentical TCRαβ + /CD19 + cell-depleted HSCT (20).…”

Avatrombopag for the treatment of thrombocytopenia in children's patients following allogeneic hematopoietic stem-cell transplantation: A pilot study

“…The donor selection and the transplant protocol were reported in previous studies ( 12 – 14 ). In general, busulfan, cyclophosphamide, and fludarabine with or without thiotepa were administrated as a myeloablative conditioning regimen for both HLA-matched and HLA-mismatched patients.…”

Applying Rituximab During the Conditioning Regimen Prevents Epstein–Barr Virus Infection Following Allogeneic Hematopoietic Stem Cell Transplant in a Children’s Cohort: A Retrospective Case–Control Study

“…EBV disease was defined as a positive EBV-encoded RNA (EBER) biopsy or positive EBV-DNA in bronchoalveolar lavage fluid or cerebral spinal fluid by qPCR with supporting clinical manifestation. Cytomegalovirus (CMV) infection was defined as the detection of > 500 IU/ml viral nucleic acid in plasma by qPCR [ 18 ]. PTLD and lymphoma were diagnosed using a biopsy in addition to positron emission tomography-computed tomography (PET-CT) [ 19 ].…”