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Viral infections in children undergoing hematopoietic stem cell transplant
H C Maltezou1, D A Kafetzis, D Abisaid
1Department of Medical Specialties, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Insights
Viral infections are common and serious complications for pediatric hematopoietic stem cell transplant recipients. Despite antiviral prophylaxis, morbidity and mortality remain high, highlighting the need for improved immune recovery and new antiviral therapies.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Transplantation Immunology
Background:
- Viral infections pose significant clinical challenges for hematopoietic stem cell transplant (HSCT) recipients.
- Limited data exists on viral infections specifically within the pediatric HSCT population.
- This study retrospectively analyzes viral infection impact in pediatric HSCT patients under a consistent antiviral prophylaxis protocol.
Purpose of the Study:
- To evaluate the incidence, clinical impact, and outcomes of viral infections in pediatric HSCT recipients.
- To identify risk factors associated with the development of viral diseases post-transplant.
- To assess the effectiveness of current antiviral prophylaxis strategies.
Main Methods:
- Retrospective review of medical records for pediatric and adolescent HSCT recipients.
- Data collected from July 1992 to August 1996 at The University of Texas M. D. Anderson Cancer Center.
- Analysis included viral diagnoses, clinical presentation, and patient outcomes.
Main Results:
- 70 viral infection episodes occurred in 96 HSCTs during the study period.
- Cytomegalovirus, varicella-zoster virus, and herpes simplex virus were the most frequent pathogens.
- 62% probability of developing viral disease; 10% mortality directly from infection within 4 months post-transplant.
- Acute graft-vs.-host disease and prolonged pre-engraftment neutropenia were significant risk factors for viral disease.
Conclusions:
- Viral infections are prevalent and associated with substantial morbidity and mortality in pediatric HSCT.
- Current antiviral prophylaxis protocols have limitations in preventing severe outcomes.
- Enhancing immune reconstitution and developing novel antiviral agents are crucial for improving prognosis in pediatric HSCT recipients.
Background:
Although viral infection is a major clinical problem for hematopoietic stem cell transplant recipients, there are few large series reporting on these infections in the pediatric population. We performed a retrospective analysis of the impact of viral infections in this patient population in our center, managed by a uniform antiviral prophylaxis protocol.
Method:
We reviewed the medical records of consecutive children and adolescents who received hematopoietic stem cell transplantation at the Division of Pediatrics, The University of Texas M. D. Anderson Cancer Center in Houston, TX, from July, 1992 to August, 1996.
Results:
During the study period there were 70 episodes of viral infections in 96 transplants. The viruses most commonly encountered were cytomegalovirus (24), varicella-zoster (21) and herpes simplex (10). Fifty of these episodes resulted in clinically apparent diseases, affecting 39 patients. The Kaplan-Meier estimated probability for the development of viral diseases was 62%. Ten percent of these patients died as a direct result of the infectious process, all within 4 months of transplant. Significant factors for development of viral disease were the development of acute graft-vs.-host disease and the duration of preengraftment neutropenia.
Conclusions:
Viruses are common pathogens after hematopoietic stem cell transplantation in the pediatric population. Despite routine antiviral prophylaxis the morbidity and mortality of viral infections remain high. Enhancement of immune recovery after hematopoietic stem cell transplantation together with the development of new classes of antiviral agents may impact the incidence and prognosis of viral infections in this setting.