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Published on: May 7, 2012
Cytomegalovirus infection in pediatric haploidentical stem cell transplantation
Abdulrahman AlSweed1, Suliman Aljumaah1, Hawazen AlSaedi2
1Department of Pediatrics, Section of Infectious Disease, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Background:
Human cytomegalovirus (CMV) is a major source of morbidity and mortality in pediatric hematopoietic stem cell transplantation (HSCT). CMV replication is mainly controlled by T-cell-mediated immunity. Despite treatment, CMV reactivation continues to have a significant adverse impact on post-transplant outcomes. In this study, we examine the clinical aspects and risk factors for CMV reactivation and disease, and the effect of therapeutic interventions in pediatric patients who underwent HSCT.
Methods:
This retrospective, single-center study included pediatric patients who underwent haploidentical HSCT at King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia, from 2013 to 2018.
Results:
A total of 94 HSCT recipients were included: 46 (48.94%) females and 48 (51.06%) males, with a median age of 5 years [interquartile range (IQR): 1.2-8.7]. As for donors, 57 (60.64%) were males and 37 (39.36%) were females, with a median age of 30.7 years (IQR: 23.0-35.3). CMV reactivation occurred in 52 (55.32%) of the HSCT patients. The overall mortality rate was 12.77% (12/94), and of those, 83.33% (10/12) were CMV positive. However, no patient developed CMV pneumonitis, gastritis, or colitis, and CMV was not identified as the direct cause of death. Regarding CMV risk factors, higher recipient age and the presence of acute graft-versus-host disease were significantly associated with CMV reactivation (P < 0.05).
Conclusion:
Preventing CMV infection significantly impacts the post-transplant course, especially in the setting of mismatched donors. This study showed that preventing CMV by preemptive therapy revealed an undetectable rate of 78.85%. Current polymerase chain reaction (PCR)-directed surveillance and prophylaxis have lowered the incidence of CMV disease and persistent DNAemia.
Insights
Human cytomegalovirus (CMV) reactivation is common after pediatric hematopoietic stem cell transplantation (HSCT). Preemptive therapy significantly reduced CMV infection rates, improving post-transplant outcomes.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Transplantation Immunology
Background:
- Human cytomegalovirus (CMV) poses significant risks in pediatric hematopoietic stem cell transplantation (HSCT), contributing to morbidity and mortality.
- T-cell immunity is crucial for controlling CMV replication, yet reactivation remains a challenge impacting post-transplant outcomes.
Purpose of the Study:
- To investigate the clinical features and risk factors associated with CMV reactivation and disease in pediatric HSCT recipients.
- To evaluate the effectiveness of therapeutic interventions for CMV in this patient population.
Main Methods:
- Retrospective, single-center study of pediatric patients undergoing haploidentical HSCT.
- Data collected from 2013 to 2018 at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Main Results:
- CMV reactivation occurred in 55.32% of 94 pediatric HSCT recipients.
- Higher recipient age and acute graft-versus-host disease were significant risk factors for CMV reactivation (P < 0.05).
- Mortality rate was 12.77%, with 83.33% of deaths in CMV-positive patients, though CMV was not the direct cause.
Conclusions:
- Preventive strategies, particularly preemptive therapy, are crucial for managing CMV in pediatric HSCT, especially with mismatched donors.
- PCR-directed surveillance and prophylaxis effectively reduce CMV disease and persistent DNAemia.
- Preemptive therapy achieved an undetectable CMV rate of 78.85% in this cohort.
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