title: Cytomegalovirus infection in pediatric allogenic hematopoietic stem cell transplantation. A single center experience.
abstract: We report a retrospective analysis of Cytomegalovirus (CMV) infection: incidence, recurrence, resistance, and subsequent disease of 81 children who underwent allogenic hematopoietic stem cell transplantation (HSCT). The recipient and/or donor's CMV serology was positive prior to transplant [recipient (R+) and/or donor (D+)]. CMV was monitored by RT-PCR starting from the first week post transplant. Forty patients showed CMV infection (49, 5%). Of them 10 manifested CMV disease leading to four deaths. In univariate analysis, factors associated with CMV infection were CMV R+ P < .01, CMV R+/D+ pair P < .01, nonbone marrow (BM) stem cell source P < .05, nonirradiation conditioning regimen P < .05, Antithymocyte globulin (ATG) P < .01. Factors associated with CMV resistance were: >1 HLA allele mismatch P < .05, CMV R +/D-pair P < .01, CMV D-P < .01, non-BM P < .05, nongenoidentical transplant P < .01. CMV disease was influenced by >1 HLA allele mismatch (P < .001), non-BM (P < .01). On multivariate analysis, CMV R+/D- (P < .05), corticosteroids ≥2 mg/kg P < .01, ATG P < .01 and non-BM (P < .05) were independent factors for CMV infection. CMV R+ transplant is associated with more CMV infection and resistance to preemptive treatment. Prolonged immune suppression (IS) worsens outcome of CMV infection and should be shortened whenever possible.
authors.affiliation: Pediatric Department, National Research Center , Cairo , Egypt.
authors.forename: M
authors.initials: M
authors.lastname: Sedky
authors.forename: Y
authors.initials: Y
authors.lastname: Mekki
authors.forename: V
authors.initials: V
authors.lastname: Mialou
authors.forename: N
authors.initials: N
authors.lastname: Bleyzac
authors.forename: S
authors.initials: S
authors.lastname: Girard
authors.forename: E
authors.initials: E
authors.lastname: Salama
authors.forename: H
authors.initials: H
authors.lastname: Abdel Rahman
authors.forename: Y
authors.initials: Y
authors.lastname: Bertrand
mesh_terms: D000293:Adolescent; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000401:mortality* / Q000517:prevention & control; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014916:Whole-Body Irradiation
chemical_list: D000961:Antilymphocyte Serum; D000998:Antiviral Agents
keywords: CMV; HSCT; infection; preemptive; serology