Epidemiology and outcome for viremia in children undergoing bone marrow transplant: A retrospective cohort study
Robyn Silcock1,2, Katriona Mitchell3, Chris Fraser1
1Queensland Children's Hospital, Brisbane, Qld, Australia.
Insights
Viremia affects nearly 40% of pediatric hematopoietic stem cell transplant (HSCT) patients, with human adenovirus (HAdV) and cytomegalovirus (CMV) being common. Viral infections significantly impact outcomes, guiding clinical decisions.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Transplant Immunology
Background:
- Viral infections are a significant threat to pediatric patients undergoing hematopoietic stem cell transplant (HSCT).
- Limited data exists on the simultaneous prevalence, risk factors, and outcomes of multiple viruses in pediatric HSCT, especially from Australasia.
- This study details the real-world experience of viremia in pediatric HSCT at a single tertiary center.
Purpose of the Study:
- To determine the prevalence, risk factors, and outcomes of viremia in pediatric HSCT recipients.
- To analyze the incidence of specific viruses including human adenovirus (HAdV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpes virus 6 (HHV-6).
- To provide the first pediatric-specific Australasian data on viremia post-HSCT.
Main Methods:
- Retrospective analysis of pediatric HSCT episodes from 2000 to 2018.
- Identification of viremia through polymerase chain reaction (PCR) testing for HAdV, CMV, EBV, and HHV-6.
- Extraction of patient data from medical charts and pathology results.
Main Results:
- Viremia occurred in 39.8% of HSCT episodes, with 21.6% disseminated and 18% involving multiple viruses.
- HAdV was most frequent (24.3%), particularly in autologous transplants. CMV (16.0%), EBV (13.5%), and HHV-6 (8.5%) were also detected.
- Viral-associated mortality was 10.9%, highest for CMV (18.3%). Adenoviral dissemination correlated with lower lymphocyte counts; CMV dissemination and death linked to higher viral loads.
Conclusions:
- This study provides crucial pediatric-specific viremia data for the Australasian region.
- Findings can inform clinical strategies for prophylaxis and treatment of viral infections in pediatric HSCT.
- Understanding viral patterns and risk factors aids in improving patient outcomes.
Introduction:
Viral infections pose a serious risk for children undergoing hematopoietic stem cell transplant (HSCT). There are few published case series of prevalence, risk factors, and outcomes examining multiple viruses simultaneously, and no pediatric Australasian data published to date. We describe the real-life experience of viremia in pediatric HSCT in a single tertiary center.
Methods:
All episodes of viremia in children undergoing HSCT between 2000 and 2018 were identified by matching HSCT patients' unique identification numbers with positive blood polymerase chain reaction (PCR) results for human adenovirus (HAdV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpes virus 6 (HHV-6). Paper or electronic charts and electronic pathology results were used to extract the study variables.
Results:
Viremia was detected in 177/445 (39.8%) HSCT episodes, of which 46% were allogeneic and 19% autologous transplants. Viremia was disseminated in 96 (21.6%) episodes, with 80 (18%) having more than one virus. HAdV was detected in 108 (24.3% of total episodes) and frequently in autologous transplants, CMV in 71 (16.0%), EBV in 60 (13.5%), and HHV-6 in 38 (8.5%). Of 174 children, 19 (10.9%) died of a viral-associated cause, with viral mortality highest in CMV (18.3%), lowest in HHV-6 (2.6%) with HAdV and EBV similar (6.6% and 6.7%). Adenoviral (but not other virus) dissemination was significantly associated with lower lymphocyte count at time of first detection. CMV dissemination and death were significantly associated with initial and highest CMV viral loads (copies/mL).
Conclusion:
This study presents the first pediatric-specific Australasian data for viremia in HSCT. Findings may help guide clinicians in prophylaxis and treatment decisions.
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