title: Cytomegalovirus infections in unrelated cord blood transplantation in pediatric patients: incidence, risk factors, and outcomes.
abstract: OBJECTIVE
  Stem cells from umbilical cord blood (CB) have increasingly become a viable alternate source of progenitor cells for hematopoietic cell transplantation (HSCT). Cytomegalovirus (CMV) is thought to contribute significantly to HSCT morbidity and mortality.
  
  
  METHODS
  Retrospective case-control study in patients at tertiary care center.
  
  
  METHODS
  We determined the incidence, risk factors and outcomes for CMV infection and disease after unrelated cord blood transplantation (UCBT) in children.
  
  
  RESULTS
  Between 2003 and 2007, 73 pediatric patients underwent UCBT and 68% of recipients were CMV seropositive. The overall incidence of CMV infection, early and late CMV infection was 58.9% (43/73), 62.8% (27/43), and 37.4% (16/43), respectively. in patients with early CMV infection, 6 of 27 (22%) patients progressed to develop CMV end-organ disease including pneumonitis and retinitis. High levels CMV antigenemia ≥70 infected cells by pp65 antigenemia assay + PMNs, P=.237) were associated with a higher risk of progression to CMV disease. The development of CMV infections was higher in CMV-seropositive recipients (P<.001) and in those who developed graft-versus-host-diseases (GVhD) (P<.001). other risk factors for CMV infection include the use of high-dose corticosteroids (P<.001) and older age of the recipient at the time of transplant (P<.002). Late CMV infection was strongly associated with a previous history of early CMV infection (P<.001).
  
  
  CONCLUSIONS
  CMV infection is a significant complication in UCBT recipients in pediatric patients and is associated with an increase in transplant-related morbidity and mortality. Risk factors for CMV infections after UCBT include GvHD, use of corticosteroids, underlying diseases (hematologic malignancies) and older age. Late CMV infection was strongly associated with a previous history of CMV infection.
authors: Department of Pediatric, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. hajjar@kfshrc.edu.sa
authors: Sami
authors: S
authors: Al-Hajjar
authors: Amal
authors: A
authors: Al Seraihi
authors: Saleh
authors: S
authors: Al Muhsen
authors: Mouhab
authors: M
authors: Ayas
authors: Suliman
authors: S
authors: Al Jumaah
authors: Abdullah
authors: A
authors: Al Jefri
authors: Mohamed
authors: M
authors: Shoukri
authors: Hassan
authors: H
authors: El Solh
mesh_terms: D000367:Age Factors; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000209:etiology* / Q000821:virology; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology; D019337:Hematologic Neoplasms / Q000473:pathology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D010750:Phosphoproteins / Q000378:metabolism; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014763:Viral Matrix Proteins / Q000378:metabolism; D014775:Virus Activation
chemical_list: D000893:Anti-Inflammatory Agents; D000914:Antibodies, Viral; D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa; D008775:Methylprednisolone