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Cytomegalovirus Reactivation as a Risk Factor for All-Cause Mortality in Children Undergoing Hematopoietic Stem Cell Transplantation: Experience Over Two Decades from a Tertiary Referral Center in India.

Authors :
Chakraborty S
Swaminathan VV
Ganesan K
Duraisamy S
Meena S
Jayakumar I
Krishna V
Uppuluri R
Raj R
Source :
Indian journal of hematology & blood transfusion : an official journal of Indian Society of Hematology and Blood Transfusion [Indian J Hematol Blood Transfus] 2024 Jan; Vol. 40 (1), pp. 91-96. Date of Electronic Publication: 2023 Apr 17.
Publication Year :
2024

Abstract

The aim of the study was to analyse the burden of cytomegalovirus (CMV) disease in children undergoing hematopoietic stem cell transplantation (HSCT) and its correlation with all-cause mortality. We performed a retrospective study in children up to 18 years of age who underwent allogeneic HSCT between February 2002 to December 2021 in the pediatric blood and marrow transplantation unit. A total of 1035 patients were included where five hundred forty-three (52.4%) patients underwent matched family donor (MFD) HSCT, 213 (20.5%) underwent matched unrelated donor (MUD) HSCT; 279 (26.9%) underwent haploidentical HSCT (T cell replete in 213 and T cell depleted in 66 patients). CMV reactivation was documented in 258 (24.9% patients). CMV was seen in 39 (7.2%) MFD, 77 (36.1%) MUD, 106 T cell replete (49.7%) and 36 T cell depleted (54.5%) transplants. CMV reactivation was predominantly documented in those where donor and recipient were positive (D + /R +) for CMV serostatus (77%)) prior to HSCT. Overall mortality rate was significantly higher in the CMV positive group (103/258, 39.9%), as compared to the CMV negative group (152/777, 19.6%) ( p value = 0.0001). CMV was the direct cause of death in 13/1035 children (1.2%). GvHD as a cause of death was found to be significantly higher among those with CMV ( n  = 32) as compared to those without CMV ( n  = 14) (35.6 versus 9%, p value = 0.0001). The incidence of CMV reactivation was noted in 25% of HSCT recipients, and predominantly in haploidentical HSCTs. CMV reactivation was shown to significantly impact all-cause mortality and there was a significantly increased risk of mortality due to GvHD among those with CMV reactivation.<br />Competing Interests: Conflict of interestThere are no conflicts of interest.<br /> (© The Author(s), under exclusive licence to Indian Society of Hematology and Blood Transfusion 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Details

Language :
English
ISSN :
0971-4502
Volume :
40
Issue :
1
Database :
MEDLINE
Journal :
Indian journal of hematology & blood transfusion : an official journal of Indian Society of Hematology and Blood Transfusion
Publication Type :
Academic Journal
Accession number :
38312183
Full Text :
https://doi.org/10.1007/s12288-023-01654-1