Cytomegalovirus infections in unrelated cord blood transplantation in pediatric patients: incidence, risk factors, and outcomes

• Published in: Hematology/oncology and stem cell therapy 2011, Vol.4 (2), p.67-72
• Main Authors: Al Hajjar, Sami, Al Seraihi, Amal, Al Muhsen, Saleh, Ayas, Mouhab, Al Jumaah, Suliman, Al Jefri, Abdullah, Shoukri, Mohamed, El Solh, Hassan
• Format: Article
• Language: English
• Subjects: Age Factors; Anti-Inflammatory Agents - therapeutic use; Antibodies, Viral - blood; Case-Control Studies; Child; Child, Preschool; Cord Blood Stem Cell Transplantation; Cytomegalovirus - immunology; Cytomegalovirus Infections - epidemiology; Cytomegalovirus Infections - etiology; Cytomegalovirus Infections - virology; Female; Graft vs Host Disease - drug therapy; Graft vs Host Disease - etiology; Hematologic Neoplasms - pathology; Hematology, Oncology and Palliative Medicine; Humans; Incidence; Infant; Male; Methylprednisolone - therapeutic use; Phosphoproteins - metabolism; Retrospective Studies; Risk Factors; Transplantation, Homologous; Treatment Outcome; Viral Matrix Proteins - metabolism; Virus Activation
• ISSN: 1658-3876
• DOI: 10.5144/1658-3876.2011.67

BACKGROUND AND OBJECTIVES 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. DESIGN AND SETTING Retrospective case-control study in patients at tertiary care center. PATIENTS AND 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). CONCLUSION 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.