Cytomegalovirus infection in children after bone marrow transplantation: Risk factors, clinical aspects and outcomes

Background and objectives

Cytomegalovirus (CMV) infection remains the most common and potentially severe viral complication in patients given hematopoietic stem cell transplantation. The aim of this study was to determine the incidence, risk factors and outcomes of CMV infection in pediatric BMT unit.

Material and methods

This study was a retrospective analysis of clinical, laboratory and outcome data of 131 pediatric patients who underwent BMT.

Results

The mean age of the study population was 6.5 ± 4 years. Out of 131 pediatric patients, 85 were males (64.9%). Majority of patients had hematological disorder/malignancy (n = 101; 77%) followed by solid tumors (n = 30; 23%). Most of them received allogeneic transplant (n = 92; 70.2%). CMV reactivation was observed in 38 (29%) patients; out of them, only (n = 3; 2.3%) had clinical manifestation/organ involvement and most cases of CMV were resolved (n = 35; 26.7%). Benign hematological disorder, conditioning regimen containing ATG, allogeneic BMT, graft-versus-host disease (GVHD) prophylaxis used and development of GVHD were identifiable risk factors in all patients, and lymphopenia <300/mm³ (p = 0.047) was the only identifiable risk factors in allogeneic BMT patients associated with development CMV reactivation. Patients, who had CMV reactivation had significantly higher rate of GVHD (31.6% vs 15.1%; p = 0.031), however relapse rate (21% vs 25.8%) and mortality rate (22.5% vs 33.3%) in patients with CMV reactivation vs no CMV reactivation respectively were not statistically significant. Overall survival and event free survival of patients with and without CMV antigenemia were also comparable.

Conclusions

Antigenemia-guided pre-emptive strategy with ganciclovir was very affective and CMV reactivation tended not to affect the outcome in our study cohort.