Cytomegalovirusinfection in children who underwent hematopoietic stem cell transplantation at a single center: A retrospective study of the risk factors

Abstract

CMV infection is one of the major causes of morbidity and mortality after HSCT. The aim of this single center retrospective study was to analyze risk factors for CMV infection in pediatric patients who underwent HSCT. We retrospectively reviewed the medical records of 117 pediatric patients who underwent allogeneic HSCT at Asan Medical Center between December 2000 and January 2007. After HSCT, CMV antigenemia was detected by identifying CMV pp65 early antigen in white blood cells. The incidence of CMV antigenemia was 24% (28/117) at a median of 38 days (range: 19-123 days) after HSCT. In multivariate analysis, CMV antigenemia occurred significantly more often in CMV seropositive recipients, patients who received grafts from alternative donors, T-cell depleted grafts, patients on ATG-containing conditioning regimens, or patients who received steroid for acute GVHD (p < 0.05). CMV antigenemia tend to develop earlier in patients who received ATG-containing conditioning regimens (p = 0.09). A second episode of CMV antigenemia was observed in three out of 28 patients (11%). The incidence of CMV disease was 5.9% (7/117) at a median of 97 days (range: 34-120 days). Manifestation of CMV disease included retinitis in two, pneumonitis in two, hepatitis in one, hepatitis with colitis in one, and gastritis in one. Six of the 12 patients (50%) with HG antigenemia (CMV pp65 antigen positivity > or =40 cells) developed clinical CMV disease, a rate that was significantly higher than seen in patients with LG antigenemia (6.25%; p < 0.01). We recommend that patients with these risk factors should carefully undergo regular evaluations for CMV infection. We also suggest that earlier and more aggressive preemptive treatment and serial follow-up of CMV disease is necessary in patients with HG-antigenemia.

Immune reconstitution and cytomegalovirus infection after allogeneic stem cell transplantation: the important impact of in vivo T cell depletion

“…Alemtuzumab was further associated with a tendency toward an earlier onset of CMV infection compared to patients receiving ATG or no in vivo TCD. Previous reports indicated that in vivo TCD with either ATG or alemtuzumab enhanced the CMV infection risk [15][16][17]. Our analysis including a direct comparison of both approaches revealed that ATG and alemtuzumab differentially influence the CMV infection risk, albeit that this hypothesis should be reevaluated in a larger patient cohort.…”

“…Moreover, CMV-seropositive unrelated donor stem cell recipients with a CMV-seronegative donor are reported to have a significantly higher treatment-related mortality and lower 5-year survival than those with a CMV-seropositive donor, though the impact of the donor's CMV serostatus is still controversially discussed [10,11]. Further risk factors for CMV infection and/or disease in patients after allo-SCT might include the use of in vitro or in vivo T cell depletion (TCD) with agents such as antithymocyte globulin (ATG) or alemtuzumab, GvHD prophylaxis with mycophenolate mofetil (MMF), the recipient's female sex, the use of a matched unrelated donor and the recipient's age [9,[12][13][14][15][16][17]. Three months after allo-SCT, a CD4 ?…”

Multidrug-resistant cytomegalovirus infection in a pediatric stem cell transplantation patient

“…Risk factors for CMV infection in HSCT patients include CMV seropositivity of donor and recipient, allogeneic transplantation (especially with T cell-depleted unrelated or HLA-mismatched donors) and cell source. Cord blood recipients have both longer and higher cumulative incidences of CMV infection compared to peripheral blood or allogeneic bone marrow recipients from related or unrelated donor origin (Keever-Taylor et al, 2001;Yoon et al, 2009;Yi and Kim, 2012). In HSCT patients, cellular immunity is mainly significantly impaired during the first 100 days post-transplant.…”

Herpesvirus infection following allogenic hematopoietic stem cell transplantation with TCRaβ and CD19 depletion: risk factors and outcome

“…Данная корреляция описана во многих работах и, вероятно, связана с вли-янием системной иммуносупрессии при острой РТПХ на механизмы врожденного или остаточного перене-сенного ЦМВ-специфичного иммунитета [13,35,36]. Нами продемонстрировано, что пациенты со злокаче-ственными заболеваниями имеют более высокий риск реактивации ЦМВ-инфекции по сравнению с пациен-тами с незлокачественными заболеваниями, о чем свидетельствует результат мультивариантного ана-лиза.…”

“…В моно-и мультива-риантных анализах получено значимое влияние на риск ЦМВ-виремии, предшествующей острой РТПХ > II стадии, серопозитивности реципиента до ТГСК и наличия у пациента злокачественного заболевания. КВ ЭБВ-инфекции -33% (95% ДИ [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. Фактором риска ЭБВ-виремии являлась острая РТПХ > II стадии.…”