Epidemiology of viral infections among children undergoing hematopoietic stem cell transplant: Α prospective single-center study

doi:10.1111/tid.13095

. 2019 Aug;21(4):e13095.

doi: 10.1111/tid.13095. Epub 2019 May 2.

Epidemiology of viral infections among children undergoing hematopoietic stem cell transplant: Α prospective single-center study

Affiliations

¹ Faculty of Nursing, Pediatric Clinic, "P & A Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece.
² Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.
³ Stem cell Transplant Unit, "Aghia Sophia" Children's Hospital, Athens, Greece.
⁴ Public Health Laboratories, Hellenic Pasteur Institute, Athens, Greece.
⁵ Department of Internal Medicine, Faculty of Nursing Athens, General and Oncology Hospital "Agii Anargyri", National and Kapodistrian University of Athens, Athens, Greece.

PMID: 30993823
DOI: 10.1111/tid.13095

Epidemiology of viral infections among children undergoing hematopoietic stem cell transplant: Α prospective single-center study

Konstantinos Tsoumakas et al. Transpl Infect Dis. 2019 Aug.

. 2019 Aug;21(4):e13095.

doi: 10.1111/tid.13095. Epub 2019 May 2.

Authors

Affiliations

¹ Faculty of Nursing, Pediatric Clinic, "P & A Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece.
² Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.
³ Stem cell Transplant Unit, "Aghia Sophia" Children's Hospital, Athens, Greece.
⁴ Public Health Laboratories, Hellenic Pasteur Institute, Athens, Greece.
⁵ Department of Internal Medicine, Faculty of Nursing Athens, General and Oncology Hospital "Agii Anargyri", National and Kapodistrian University of Athens, Athens, Greece.

PMID: 30993823
DOI: 10.1111/tid.13095

Abstract

Background: Viral infections are a significant cause of morbidity and mortality in pediatric transplant populations. We analyzed the epidemiology of viral infections in pediatric hematopoietic stem cell transplant (HSCT) patients, including their incidence, associated risk factors, and outcome.

Methods: In a prospective study from September 2011 to September 2015, blood, urine, and stool specimens were monitored weekly from transplantation to day 100 or after if clinically suspected, by use of real-time polymerase chain reaction. Cytomegalovirus (CMV), Epstein-Barr virus (EBV), BK polyomavirus (BKV), Herpes simplex virus-1,2, Varicella zoster virus, Human herpes virus-6,7, and Adenovirus infections were monitored. All children and adolescents who underwent HSCT received long-term follow up in the regular outpatient clinics (range 2-48 months).

Results: A total of 192 HSCTs (autologous/allogeneic: 53/139) were performed in 165 subjects (median age: 5.6 years). Viruses most commonly isolated were CMV (46.1%), BKV (25.9%) and EBV (22.6%) and were more frequent in allogeneic versus autologous transplants (P < 0.05). Almost all high-risk allogeneic recipients developed EBV infections post-HSCT. EBV-PTLD was the only cause of death among those who developed viral disease. The factors significantly associated with the development of viral infections were recipient's advanced age, unrelated donor, mismatched graft and use of peripheral blood stem cells grafts.

Conclusions: Viral infections were common among our pediatric recipients. Data suggest that monitoring of viral load may be significant to the prevention of viral disease. Particular demographic and transplantation characteristics were associated with the development of viral infections post-HSCT.

Keywords: children; hematopoietic stem cell transplant; risk factors; viral infections.

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References

REFERENCES

1. Wu JL, Ma HY, Lu CY, et al. Risk factors and outcomes of cytomegalovirus viremia in pediatric hematopoietic stem cell transplantation patients. J Microbiol Immunol Infect. 2017;50:307-313.
1. Styczynski J, Gil L, Tridello G, et al. Response to rituximab-based therapy and risk factor analysis in Epstein Barr virus-related lymphoproliferative disorder after hematopoietic stem cell transplant in children and adults: a study from the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation. Clin Infect Dis. 2013;57:794-802.
1. Rustia E, Violago L, Jin Z, et al. Risk factors and utility of a risk-based algorithm for monitoring cytomegalovirus, Epstein-Barr virus, and adenovirus infections in pediatric recipients after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2016;22:1646-1653.
1. Kang JM, Park KS, Kim JM, et al. Prospective monitoring of adenovirus infection and type analysis after allogeneic hematopoietic cell transplantation: A single-center study in Korea. Transpl Infect Dis. 2018;20:e12885.
1. Fule Robles JD, Cheuk DK, Ha SY, Chiang AK, Chan GC. Human herpesvirus types 6 and 7 infection in pediatric hematopoietic stem cell transplant recipients. Annals of Transplantation. 2014;19:269-276.

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[1] Wu JL, Ma HY, Lu CY, et al. Risk factors and outcomes of cytomegalovirus viremia in pediatric hematopoietic stem cell transplantation patients. J Microbiol Immunol Infect. 2017;50:307-313.

[2] Wu JL, Ma HY, Lu CY, et al. Risk factors and outcomes of cytomegalovirus viremia in pediatric hematopoietic stem cell transplantation patients. J Microbiol Immunol Infect. 2017;50:307-313.

[3] Styczynski J, Gil L, Tridello G, et al. Response to rituximab-based therapy and risk factor analysis in Epstein Barr virus-related lymphoproliferative disorder after hematopoietic stem cell transplant in children and adults: a study from the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation. Clin Infect Dis. 2013;57:794-802.

[4] Styczynski J, Gil L, Tridello G, et al. Response to rituximab-based therapy and risk factor analysis in Epstein Barr virus-related lymphoproliferative disorder after hematopoietic stem cell transplant in children and adults: a study from the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation. Clin Infect Dis. 2013;57:794-802.

[5] Rustia E, Violago L, Jin Z, et al. Risk factors and utility of a risk-based algorithm for monitoring cytomegalovirus, Epstein-Barr virus, and adenovirus infections in pediatric recipients after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2016;22:1646-1653.

[6] Rustia E, Violago L, Jin Z, et al. Risk factors and utility of a risk-based algorithm for monitoring cytomegalovirus, Epstein-Barr virus, and adenovirus infections in pediatric recipients after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2016;22:1646-1653.

[7] Kang JM, Park KS, Kim JM, et al. Prospective monitoring of adenovirus infection and type analysis after allogeneic hematopoietic cell transplantation: A single-center study in Korea. Transpl Infect Dis. 2018;20:e12885.

[8] Kang JM, Park KS, Kim JM, et al. Prospective monitoring of adenovirus infection and type analysis after allogeneic hematopoietic cell transplantation: A single-center study in Korea. Transpl Infect Dis. 2018;20:e12885.

[9] Fule Robles JD, Cheuk DK, Ha SY, Chiang AK, Chan GC. Human herpesvirus types 6 and 7 infection in pediatric hematopoietic stem cell transplant recipients. Annals of Transplantation. 2014;19:269-276.

[10] Fule Robles JD, Cheuk DK, Ha SY, Chiang AK, Chan GC. Human herpesvirus types 6 and 7 infection in pediatric hematopoietic stem cell transplant recipients. Annals of Transplantation. 2014;19:269-276.

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Epidemiology of viral infections among children undergoing hematopoietic stem cell transplant: Α prospective single-center study

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Epidemiology of viral infections among children undergoing hematopoietic stem cell transplant: Α prospective single-center study

Authors

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