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Impact of viral reactivations in the era of pre-emptive antiviral drug therapy following allogeneic haematopoietic SCT in paediatric recipients.
- Source :
-
Bone Marrow Transplantation . Jun2013, Vol. 48 Issue 6, p803-808. 6p. 3 Charts, 3 Graphs. - Publication Year :
- 2013
-
Abstract
- While pre-emptive rituximab therapy for EBV has substantially reduced the incidence of post-transplant lymphoproliferative disorder, following allogeneic haematopoietic SCT (HSCT), cytomegalovirus (CMV) and adenovirus (ADV) still contribute to significant morbidity and mortality after HSCT. We therefore aimed to identify high-risk children who could benefit from recent advances in virus-specific immunotherapy, define the impact of viral reactivations on survival and estimate the economic burden of pre-emptive antiviral drug therapy. Between 2005 and 2010, prospective monitoring of 291 paediatric HSCT procedures revealed that reactivation of CMV (16%), ADV (15%) and EBV (11%) was frequent during period of CD4 T-cell lymphopenia (0.15 × 109 L−1; P<0.05). We report significant risk factors for reactivation, most notably the use of serotherapy and development of GVHD (grade II) in the presence of pre-existing infection (ADV) or donor and/or recipient seropositivity (CMV, EBV). Most interestingly, CMV and ADV viraemia were the major independent predictors of mortality (P<0.05). CMV, ADV or EBV viral reactivation caused prolonged hospitalization (P<0.05), accounted for 15% of all mortality and substantially increased the cost of transplantation by ∼£22 500 ($34 000). This provides an economic rationale for targeting high-risk HSCT recipients with interventions such as virus-specific cell therapy. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 02683369
- Volume :
- 48
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- Bone Marrow Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 87951121
- Full Text :
- https://doi.org/10.1038/bmt.2012.221