Cytomegalovirus infection in children undergoing hematopoietic stem cell transplantation in Chile
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Published on: May 7, 2012
Claudia Paris1, Katherine Kopp, Alejandra King
1Bone Marrow Transplant Unit, Hospital Luis Calvo Mackenna, Santiago, Chile. claudiaparisd@yahoo.es
Insights
Cytomegalovirus (CMV) infection after pediatric hematopoietic stem cell transplantation (HSCT) showed similar incidence and outcomes compared to developed nations. Key risk factors included graft-versus-host disease and antithymocyte globulin treatment.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Transplantation Immunology
Background:
- Cytomegalovirus (CMV) infection is a significant cause of morbidity and mortality in pediatric hematopoietic stem cell transplantation (HSCT) patients.
- Assessing CMV infection incidence, risk factors, and outcomes in developing countries is crucial for improving patient care.
Purpose of the Study:
- To evaluate the incidence, risk factors, and outcomes of CMV infection in children post-HSCT in a developing country.
- To compare findings with those from industrialized nations.
Main Methods:
- Prospective study of 97 children undergoing HSCT from 1999-2005.
- Routine pre-transplant serologic studies and weekly CMV surveillance (antigenemia/PCR).
- Pre-emptive ganciclovir therapy and foscarnet for refractory cases.
Main Results:
- CMV reactivation occurred in 26 patients (27%), with 3 developing CMV disease.
- Overall survival was 67%.
- Identified risk factors included positive recipient serologic status, graft-versus-host disease (GvHD), GvHD prophylaxis, and antithymocyte globulin treatment.
Conclusions:
- The rate and prognosis of CMV infection in this pediatric HSCT program are comparable to international standards.
- Effective prevention and management strategies for CMV infection are in place.
Background:
Cytomegalovirus (CMV) infection remains as an important cause of morbidity and mortality in children undergoing hematopoietic stem cell transplantation (HSCT). Our aim was to assess the incidence, risk factors, and outcome related to CMV infection in children after HSCT in a developing country.
Methods:
From October 1, 1999, to December 31, 2005, we prospectively studied all patients admitted to the HSCT unit at Hospital Luis Calvo Mackenna in Santiago, Chile. Serologic studies before transplantation and weekly CMV infection surveillance (antigenemia or quantitative PCR) were routinely obtained. Patients with positive antigenemia or quantitative PCR received pre-emptive therapy with ganciclovir, and cases of unfavorable clinical evolution, persistent positive antigenemia, or quantitative PCR after 14 days of ganciclovir were treated with foscarnet.
Results:
Ninety-seven patients received HSCT. Their median age was 8 years (range, 3 months to 24 years) and their overall survival was 67%. CMV reactivation was diagnosed in 26 patients. Of these, three developed CMV disease (two interstitial pneumonia, one hemorrhagic cystitis). One of the patients with pneumonia died. Risk factors identified were pre-transplant serologic status (positive recipient), acute and chronic graft versus host disease (GvHD), GvHD prophylaxis, and treatment with antithymocyte globulin.
Conclusions:
The rate and prognosis of CMV infection among children treated at our HSCT unit is similar to those reported from industrialized countries. These findings reflect adequate prevention and management of CMV infection within our program.
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