Observational prospective study of viral infections in children undergoing allogeneic hematopoietic cell transplantation: a 3-year GETMON experience

• Published in: Bone marrow transplantation (Basingstoke) Vol. 46; no. 1; pp. 119 - 124
• Main Authors: Verdeguer, A, de Heredia, C D, González, M, Martínez, A M, Fernández-Navarro, J M, Pérez-Hurtado, J M, Badell, I, Gómez, P, González, M E, Muñoz, A, Díaz, M A
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.01.2011; Nature Publishing Group
• Subjects: 692/699/255/2514; 692/700/565/545/576/1955; Adenovirus; Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antilymphocyte Serum - therapeutic use; Biological and medical sciences; Bone marrow; Bone Marrow Transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Cell Biology; Child; Child, Preschool; Communicable diseases; Cord blood; Cord Blood Stem Cell Transplantation; Cytomegalovirus; Epstein-Barr virus; Female; Follow-Up Studies; Globulins; Graft vs Host Disease - complications; Graft vs Host Disease - epidemiology; Graft vs Host Disease - virology; Graft-versus-host reaction; Hematology; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Human cytomegalovirus; Human herpesvirus 6; Humans; Immunosuppression - adverse effects; Incidence; Infant; Infant, Newborn; Infections; Infectious diseases; Internal Medicine; Leukemia; Leukemia - complications; Leukemia - therapy; Leukemia - virology; Male; Medical sciences; Medicine; Medicine & Public Health; original-article; Patients; Pediatrics; Peripheral Blood Stem Cell Transplantation; Polyomavirus; Prospective Studies; Public Health; Risk factors; Spain - epidemiology; Stem cell transplantation; Stem Cells; Survival Analysis; Thymocytes; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Homologous; Transplants & implants; Varicella-zoster virus; Viral diseases; Viral infections; Viral Load; Virus diseases; Virus Diseases - complications; Virus Diseases - epidemiology; Virus Diseases - mortality; Virus Diseases - virology; Young Adult; Spain; hematopoietic cell transplantation; children; viral infection; Human; Observational study; Hematology; Stem cell; Hematopoietic cell; Homograft; Infection; Prospective; Allogeneic hematopoietic stem cell transplantation; Viral disease; Graft; Child
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2010.52

We studied surveillance, incidence and outcome of viral infections in children undergoing allogeneic hematopoietic cell transplantation (HCT) in the main pediatric transplant units in Spain. We prospectively collected data from first year post-HCT in every consecutive allogeneic HCT performed during 3 years ( N =215): first HCT=188 and second HCT=27; median age=6.6 years (0.1–20.7). Most patients had acute leukemia ( N =137) and 135 recipients (63%) were CMV seropositive. A total of 46 patients underwent cord blood transplant, 133 patients underwent HCT from alternative donors (62%) and 101 patients received anti-thymocyte globulin. Observational time was completed in 137 patients, whereas the remaining 78 died after a median survival time of 99 days (3–352). CMV was monitored in all patients; adenovirus (ADV) and human herpesvirus 6 (HHV-6) were monitored in 101 and 33 patients, respectively. We found 145 viral infections in 103 patients: CMV ( n =42), ADV ( n =32), HHV-6 ( n =7), polyomavirus ( n =20), EBV ( n =6), VZV ( n =17) and others ( n =8). CMV infection was significantly higher in seropositive patients (25 vs 7%) ( P =0.02). Extensive chronic GVHD (cGVHD) was significantly associated with an increased rate of viral infections (12 of 16 patients with cGVHD had infections vs 91 of 199 without GVHD) ( P =0.035). In total, 10 patients (4.6%) died of viral infections (CMV=5, ADV=3, respiratory=2). We found a high incidence of viral infection, but mortality was low.