Open AccessFactors associated with cytomegalovirus infection in children undergoing allogeneic hematopoietic stem-cell transplantation
Author(s) -
TangHer Jaing,
TsungYen Chang,
Shih-Hsiang Chen,
YuChuan Wen,
Ting-Jiuan Yu,
Ching-Fen Lee,
Chao-Ping Yang,
Pei-Kwei Tsay
Publication year - 2019
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000014172
Subject(s) - medicine , ganciclovir , hematopoietic stem cell transplantation , viremia , cytomegalovirus , transplantation , immunology , univariate analysis , foscarnet , incidence (geometry) , human cytomegalovirus , betaherpesvirinae , viral disease , multivariate analysis , herpesviridae , antibody , virus , physics , optics
While preemptive therapy with ganciclovir (GCV) for cytomegalovirus (CMV) infection is used following allogeneic hematopoietic stem-cell transplantation (HSCT), risk factors for CMV infection in children undergoing HSCT are poorly understood. We studied CMV reactivation following allogeneic HSCT by retrospectively analyzing pediatric patients who received allogeneic HSCT and preemptive GCV therapy between 1998 and 2016. The level of viremia requiring preemptive GCV therapy was >1 CMV antigen-positive cells per 5 × 10 5 leukocytes during the antigenemia assay era and >1000 copies/mL in the polymerase chain reaction era. Among 290 at-risk patients, 54 (18.6%) patients had primary CMV infection or CMV reactivation occurring at a median of 76 days (range, 7–234) following HSCT. CMV reactivation occurred in 28.2% (44/156) of CMV-seropositive transplant recipients at a median of 26 days posttransplant. Univariate and multivariate analyses revealed statistically significant relationships between CMV infection and grade III–IV acute graft-vs-host disease, seronegative donor/seropositive recipient combination, and unrelated/mismatched donors. The remaining demographic factors were not predictive of CMV infection. The seronegative donor/seropositive recipient combination for HSCT was associated with an incomplete response to antiviral therapy. Human leukocyte antigen identical donors were the best choice for patients undergoing allogeneic HSCT to reduce the incidence of CMV disease and mortality.