Risk factors and incidence of cytomegalovirus viremia and disease in pediatric patients with allogeneic hematopoietic stem cell transplantation: An 8‐year single‐center experience in Latin America

Abstract

Background: Cytomegalovirus infection represents a significant cause of morbidity and mortality after hematopoietic stem cell transplantation. This study aimed to evaluate the incidence of viremia and disease due to cytomegalovirus and the risk factors in pediatric patients with hematopoietic stem cell transplantation in our institution. Methods: This was a retrospective cohort of patients under 19 years of age who underwent allogeneic hematopoietic stem cell transplantation due to any indication between 2012 and 2019. The analysis included the diagnosis of cytomegalovirus viremia or disease during post-transplant follow-up, evaluation of risk factors, and outcomes.The statistical analysis included univariate and multivariate analyses, and the cumulative incidence of cytomegalovirus viremia was determined by the Kaplan-Meier method using STATA 14 statistical software.Results: A total of 182 transplants were included. At 100 days, the cumulative incidence of cytomegalovirus viremia was 70.5%, and that of cytomegalovirus disease was 4.7%. Overall survival at 2 years was 74%, and event-free survival was 64%. The remaining demographic characteristics were not predictors of infection. There was no association between viremia and relapse or survival of the patients. Higher mortality was noted in cytomegalovirus disease.Conclusions: During the study period, the incidence of cytomegalovirus disease was similar to that of other pediatric reports, but the incidence of viremia was higher. Preemptive therapy has diminished disease rates and death due to infection. Viral load cutoff points should be standardized to guide treatment and avoid myelotoxicity.

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

“…Our result was quite similar to a current study in which the cumulative incidences of CMV DNAemia in the MSD, MUD and haploidentical groups were 39.0, 55.6, and 85.7%, respectively ( Lin et al., 2019 ). Another retrospective pediatric patient study from a single center in Latin America showed that the cumulative incidence of CMV viremia was 70.5% while CMV disease was 4.7% ( Aristizabal et al., 2022 ).…”

“…Unlike other studies ( Ganepola et al., 2007 ; Schmidt-Hieber et al., 2013 ; Takenaka et al., 2015 ), we have not identified the CMV serostatus of donor and recipient as a significant factor, which might result from the existing unknown data. Eventually, it was well established that CMV infection was associated with overall mortality especially CMV disease ( Rowe et al., 2016 ; Aristizabal et al., 2022 ; Ru et al., 2022 ). Therefore, we recommend that it was required to carefully and rigorously monitor CMV infection after haplo-HSCT in leukemia patients in whom letermovir may be appropriately used for prophylaxis in the future study (2).…”

“…Cytomegalovirus (CMV) infection is a common and critical viral infection in allogeneic hematopoietic stem cell transplant (allo-HSCT) ( Stern and Papanicolaou, 2019 ; Shafat et al., 2020 ). The incidence of CMV infection is around 40-70% based on diverse types of transplantation as well as territory ( Walker et al., 2007 ; Cannon et al., 2010 ; Schmidt-Hieber et al., 2013 ; Dziedzic et al., 2017 ; Solano et al., 2021 ; Aristizabal et al., 2022 ). CMV infection is associated with an increased risk of mortality ( Dziedzic et al., 2017 ; Stern and Papanicolaou, 2019 ) [hazard ratio of 1.5 from a systemic review ( Gimenez et al., 2019 )].…”