Yonsei Med J.  2012 Mar;53(2):393-400. 10.3349/ymj.2012.53.2.393.

Cytomegalovirus Infection according to Cell Source after Hematopoietic Cell Transplantation in Pediatric Patients

• Yi ES
• Kim YJ

• KMID: 1120208
• DOI: http://doi.org/10.3349/ymj.2012.53.2.393

Abstract

PURPOSE
This study was performed in order to evaluate the incidence and characteristics of cytomegalovirus (CMV) infection in children with acute leukemia according to donor source and graft type.
MATERIALS AND METHODS
We retrospectively identified children with acute leukemia who had received allogeneic hematopoietic cell transplantation at Samsung Medical Center in Korea from October 1998 to December 2009.
RESULTS
In total, 134 recipients were identified. The patients were classified into the following three groups: unrelated cord blood (CB, n=36), related bone marrow or peripheral blood stem cells (RD, n=41), and unrelated bone marrow or peripheral blood stem cells (UD, n=57). The 365-day cumulative incidence of CMV antigenemia was not significantly different among the three groups (CB 67% vs. RD 49% vs. UD 65%, p=0.17). However, CB recipients had the highest median value of peak antigenemia (CB 160/2x10(5) leukocytes vs. RD 7/2x10(5) leukocytes vs. UD 19/2x10(5) leukocytes, p<0.01) and the longest duration of CMV antigenemia than the other stem cell source recipients (CB 87 days vs. RD 17 days vs. UD 28 days, p<0.01). In addition, the 730-day cumulative incidence of CMV disease was the highest in the CB recipients (CB 36% vs. RD 2% vs. UD 5%, p<0.01). Thirteen CB recipients developed CMV disease, in which five of them had more than one organ involvement. Two patients, who were CB recipients, died of CMV pneumonia.
CONCLUSION
This study suggests that CB recipients had both longer and higher cumulative incidences of CMV infection. Therefore, a more aggressive and effective strategy of CMV management should be considered in CB recipients.

Keyword

CMV; cord blood; stem cell transplantation; leukemia

MeSH Terms

Acyclovir/therapeutic use
Adolescent
Antiviral Agents/therapeutic use
Child
Child, Preschool
Cyclosporine/therapeutic use
Cytomegalovirus Infections/*diagnosis/drug therapy/etiology
Female
Graft vs Host Disease/diagnosis/drug therapy/etiology
Hematopoietic Stem Cell Transplantation/*adverse effects
Humans
Immunosuppressive Agents/therapeutic use
Infant
Leukemia/therapy
Male
Retrospective Studies
Young Adult

Figure

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  Fig. 1 Cumulative incidence of CMV antigenemia. CB, cord blood; UD, unrelated bone marrow or peripheral blood stem cell donor; RD, related bone marrow or peripheral blood stem cell donor; CMV, cytomegalovirus.

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  Fig. 2 Cumulative incidence of CMV disease. CB, cord blood; UD, unrelated bone marrow or peripheral blood stem cell donor; RD, related bone marrow or peripheral blood stem cell donor; CMV, cytomegalovirus.

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