Risk factors and outcomes of cytomegalovirus viremia in pediatric hematopoietic stem cell transplantation patients.
BACKGROUND
Cytomegalovirus (CMV) is a major pathogen causing significant mortality and morbidity in immunocompromised hosts. It is important to find risk factors associated with CMV viremia and its outcome.


METHODS
We investigated the incidence, time of onset, risk factors for CMV viremia, and characteristics of CMV diseases in 57 pediatric patients receiving hematopoietic stem cell transplantation (HSCT). Between August 2011 and March 2014, cases of pediatric HSCT patients at the National Taiwan University Children's Hospital were reviewed. Viremia was identified by plasma CMV real-time polymerase chain reaction (RT-PCR) assay.


RESULTS
Eighteen (32%) of the 57 patients developed CMV viremia at a median of 23 days post-HSCT (range -3 to +721 days). Eighty-nine percent (16/18) of CMV viremia occurred within 100 days posttransplantation. Four patients finally had CMV diseases (1 with CMV colitis and 3 with CMV pneumonitis) and one patient died of CMV pneumonitis complicated with pulmonary hemorrhage and sepsis. Significant risk factors associated with CMV viremia via univariate analysis include older age (p = 0.03), leukemic patients [odds ratio (OR): 5.2, 95% confidence interval (CI): 1.52∼17.7, p = 0.008), allogeneic HSCT (OR: 14.57, 95% CI: 1.76∼120.5, p = 0.002), antithymoglobulin (ATG) use before transplantation (OR: 5.09, 95% CI: 1.52∼16.9, p = 0.007), graft-versus-host disease (GvHD) (OR: 10.1, 95% CI: 2.7∼38.7, p < 0.001), and gastrointestinal GvHD (OR: 10.9, 95% CI: 2.72∼43.9, p = 0.001).


CONCLUSIONS
In pediatric posttransplantation patients, CMV viremia mostly occurred within 100 days after transplantation. Risk factors associated with CMV viremia include older diagnostic age, leukemic patients, unrelated donor HSCT, pretransplant ATG use, GvHD, and gastrointestinal GvHD.
Division of Infectious Disease, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan, ROC.
Jhong-Lin
JL
Wu
Division of Infectious Disease, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan, ROC.
Hsuan-Yin
HY
Ma
Division of Infectious Disease, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan, ROC.
Chun-Yi
CY
Lu
Division of Infectious Disease, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan, ROC.
Jong-Min
JM
Chen
Division of Infectious Disease, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan, ROC.
Ping-Ing
PI
Lee
Division of Hematology-Oncology, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan, ROC.
Shiann-Tarng
ST
Jou
Division of Hematology-Oncology, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan, ROC.
Yung-Lin
YL
Yang
Division of Hematology-Oncology, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan, ROC.
Hsiu-Hao
HH
Chang
Division of Hematology-Oncology, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan, ROC.
Meng-Yao
MY
Lu
Division of Infectious Disease, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan, ROC. Electronic address: ly7077@tpts6.seed.net.tw.
Luan-Ying
LY
Chang
Division of Infectious Disease, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan, ROC.
Li-Min
LM
Huang
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000473:pathology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006776:Hospitals, Pediatric; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D066027:Transplant Recipients; D016896:Treatment Outcome; D014766:Viremia / Q000453:epidemiology* / Q000473:pathology; D055815:Young Adult
D004279:DNA, Viral
Cytomegalovirus; Hematopoietic stem cell transplantation; Pediatrics; Risk factors