title: 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.
abstract: Infectious complications, particularly viral infections, remain a significant cause of morbidity and mortality after allogeneic hematopoietic cell transplantation (alloHCT). Only a handful of studies in children have analyzed the risks for and impact of viremia on alloHCT-related outcomes. We conducted a retrospective study of 140 pediatric patients undergoing alloHCT to investigate the incidence of and risk factors for cytomegalovirus (CMV), adenovirus (ADV), and Epstein-Barr virus (EBV) viremia and viral disease after alloHCT. Furthermore, we assessed the impact of viremia on days of hospitalization and develop an algorithm for routine monitoring of viremia. Patients were monitored before alloHCT and then weekly for 180 days after alloHCT. Patients were considered to have viremia if CMV were > 600 copies/mL, EBV were > 1000 copies/mL, or ADV were > 1000 copies/mL on 2 consecutive PCRs. The overall incidences of viremia and viral disease in all patients from day 0 to +180 after alloHCT were 41.4% (n = 58) and 17% (n = 24), respectively. The overall survival for patients with viremia and viral disease was significantly lower compared with those without viremia (58% versus 74.2%, P = .03) and viral disease (48.2% versus 71.2%, P = .024). We identified that pretransplantation CMV risk status, pre-alloHCT viremia, and use of alemtuzumab were associated with the risk of post-alloHCT viremia. The average hospitalization days in patients with CMV risk (P = .011), viremia (P = .024), and viral disease (P = .002) were significantly higher. The algorithm developed from our data can potentially reduce viral PCR testing by 50% and is being studied prospectively at our center. Improved preventative treatment strategies for children at risk of viremia after alloHCT are needed.
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Rustia
authors.affiliation: Department of Nursing, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York.
authors.forename: Leah
authors.initials: L
authors.lastname: Violago
authors.affiliation: Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Foca
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Justine M
authors.initials: JM
authors.lastname: Kahn
authors.affiliation: Department of Pediatrics, Emory University, Atlanta, Georgia.
authors.forename: Staci
authors.initials: S
authors.lastname: Arnold
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Jean
authors.initials: J
authors.lastname: Sosna
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Monica
authors.initials: M
authors.lastname: Bhatia
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Kung
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Diane
authors.initials: D
authors.lastname: George
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: James H
authors.initials: JH
authors.lastname: Garvin
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York. Electronic address: ps2087@columbia.edu.
authors.forename: Prakash
authors.initials: P
authors.lastname: Satwani
mesh_terms: D000257:Adenoviridae Infections; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections; D020031:Epstein-Barr Virus Infections; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007223:Infant; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D066027:Transplant Recipients; D014184:Transplantation, Homologous / Q000009:adverse effects*; D014766:Viremia / Q000209:etiology*; D055815:Young Adult
keywords: Bone marrow transplantation; Pediatrics; Viral infections