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Prevalence of viral infection and reactivation over 10 years of HSCT in pediatric patients
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Infection is a major post-transplant complication in patients undergoing HSCT and can be a major cause of mortality, particularly in pediatric patients.1 Peri-transplant viral reactivation can lead to graft failure and aGvHD.1 A retrospective analysis across 10 years of pediatric HSCTs performed at UCLA Mattel Children’s Hospital from January 2008 to December 2017 assessed viral infections, reactivations, and factors associated with these in 139 patients, with results published by Lau et al.1 in the Journal of Hematology. Conditioning regimens were based on individual factors including primary diagnosis and disease status. Cell sources included umbilical cord blood, peripheral blood stem cells, and bone marrow.1 |
| Key learnings |
| Post-transplant viral infections occurred in 47.7% of patients overall, with multiple infections in 19.9% of patients. The most common viral infections were CMV (24.5%), HHV6 (14.5%), and BK (12.6%). |
| Acyclovir effectively reduced HSV reactivation. Viruses such as HHV6 and adenovirus lack standardized prophylaxis, indicating a need for targeted antiviral strategies. Viral encephalitis occurred in 4.6% of patients (57% caused by HHV6) and was linked to high mortality (85.7%). |
| CMV infection was a major contributor to transplant-related mortality, with deaths in 42.9% of patients with CMV. The majority of patients with CMV experienced CMV reactivation. Ganciclovir prophylaxis reduced but did not eliminate the risk of reactivation. |
| Post-transplant viral infection and viral reactivation were associated with poor outcomes, including increased risk of aGvHD and increased mortality rate. Early surveillance for infection and use of prophylaxis in high-risk patients is key for improving outcomes. |
Abbreviations: aGvHD, acute graft-versus-host disease; BK, human polyoma virus 1; CMV, cytomegalovirus; HHV6, human herpes virus 6; HSV, herpes simplex virus.
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