title: Opportunistic virus DNA levels after pediatric stem cell transplantation: serostatus matching, anti-thymocyte globulin, and total body irradiation are additive risk factors.
abstract: Viral opportunistic infections remain a threat to survival after stem cell transplantation (SCT). We retrospectively investigated infections caused by cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus type 6 (HHV6), or adenovirus (AdV) during the first 6-12 months after pediatric SCT. Serum samples from 47 consecutive patients were analyzed by quantitative real-time polymerase chain reaction assay. DNAemia at any time point occurred for CMV in 47%, for EBV in 45%, for HHV6 in 28%, and for AdV in 28%. Three patients (6.3%) died of CMV-, EBV-, or AdV-related complications 4, 9, and 24 weeks after SCT, respectively, representing 21% of total mortality. These 3 cases were clearly distinguishable by DNAemia increasing to high levels. Serum positivity for CMV immunoglobulin G in either recipient or donor at the time of SCT, total body irradiation, and anti-thymocyte globulin conditioning were independent risk factors for high CMV or EBV DNA levels. We conclude that DNAemia levels help to distinguish significant viral infections, and that surveillance and prophylactic measures should be focused on patients with risk factors in whom viral complications rapidly can become fatal.
authors: Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. carola.kullberg-lindh@pediat.gu.se
authors: C
authors: C
authors: Kullberg-Lindh
authors: K
authors: K
authors: Mellgren
authors: V
authors: V
authors: Friman
authors: A
authors: A
authors: Fasth
authors: H
authors: H
authors: Ascher
authors: S
authors: S
authors: Nilsson
authors: M
authors: M
authors: Lindh
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000097:blood; D000961:Antilymphocyte Serum; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004266:DNA Virus Infections / Q000209:etiology* / Q000517:prevention & control* / Q000821:virology; D004267:DNA Viruses / Q000235:genetics / Q000276:immunology; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D014766:Viremia / Q000097:blood; D014916:Whole-Body Irradiation / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D000914:Antibodies, Viral; D000961:Antilymphocyte Serum; D000998:Antiviral Agents; D004279:DNA, Viral; D007074:Immunoglobulin G