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

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 R...

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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
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container_title Hematology/oncology and stem cell therapy
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creator Al Hajjar, Sami
Al Seraihi, Amal
Al Muhsen, Saleh
Ayas, Mouhab
Al Jumaah, Suliman
Al Jefri, Abdullah
Shoukri, Mohamed
El Solh, Hassan
description 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.
doi_str_mv 10.5144/1658-3876.2011.67
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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 &lt; .001) and in those who developed graft-versus-host-diseases (GVHD) ( P &lt; .001). Other risk factors for CMV infection include the use of high-dose corticosteroids ( P &lt; .001) and older age of the recipient at the time of transplant ( P &lt; .002). Late CMV infection was strongly associated with a previous history of early CMV infection ( P &lt; .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.</description><identifier>ISSN: 1658-3876</identifier><identifier>DOI: 10.5144/1658-3876.2011.67</identifier><identifier>PMID: 21727767</identifier><language>eng</language><publisher>England: Elsevier B.V</publisher><subject>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</subject><ispartof>Hematology/oncology and stem cell therapy, 2011, Vol.4 (2), p.67-72</ispartof><rights>King Faisal Specialist Hospital</rights><rights>2011 King Faisal Specialist Hospital</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3657-27d6de5e291bfa8c15f3b7f7a69e6ee47e9bd627713dca0d02330ccc8ee077f03</citedby><cites>FETCH-LOGICAL-c3657-27d6de5e291bfa8c15f3b7f7a69e6ee47e9bd627713dca0d02330ccc8ee077f03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1658387611500408$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,778,782,3538,4012,27910,27911,27912,45767</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21727767$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Al Hajjar, Sami</creatorcontrib><creatorcontrib>Al Seraihi, Amal</creatorcontrib><creatorcontrib>Al Muhsen, Saleh</creatorcontrib><creatorcontrib>Ayas, Mouhab</creatorcontrib><creatorcontrib>Al Jumaah, Suliman</creatorcontrib><creatorcontrib>Al Jefri, Abdullah</creatorcontrib><creatorcontrib>Shoukri, Mohamed</creatorcontrib><creatorcontrib>El Solh, Hassan</creatorcontrib><title>Cytomegalovirus infections in unrelated cord blood transplantation in pediatric patients: incidence, risk factors, and outcomes</title><title>Hematology/oncology and stem cell therapy</title><addtitle>Hematol Oncol Stem Cell Ther</addtitle><description>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 &lt; .001) and in those who developed graft-versus-host-diseases (GVHD) ( P &lt; .001). Other risk factors for CMV infection include the use of high-dose corticosteroids ( P &lt; .001) and older age of the recipient at the time of transplant ( P &lt; .002). Late CMV infection was strongly associated with a previous history of early CMV infection ( P &lt; .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. 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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 &lt; .001) and in those who developed graft-versus-host-diseases (GVHD) ( P &lt; .001). Other risk factors for CMV infection include the use of high-dose corticosteroids ( P &lt; .001) and older age of the recipient at the time of transplant ( P &lt; .002). Late CMV infection was strongly associated with a previous history of early CMV infection ( P &lt; .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. 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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
title Cytomegalovirus infections in unrelated cord blood transplantation in pediatric patients: incidence, risk factors, and outcomes
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