Cytomegalovirus Infections Following Pediatric Hematopoietic Stem Cell Transplantation: An 18-Year Single-Center Experience.

Aim

The aim of this study was to evaluate the risk factors for CMV reactivation and the effects of CMV on HSCT outcomes in patients managed using a standard prophylaxis and preemptive treatment approach in settings where letermovir prophylaxis could not be used.

Methods

Patients who underwent HSCT between January 2006 and December 2023 in our pediatric hematology department were included in this retrospective study.

Results

Among 217 patients included, 96 (44.4%) underwent HSCT for malignant diseases. The donor was a matched-sibling for 65.4%, and 86.1% had myeloablative conditioning regimen. All patients received acyclovir prophylaxis (1500 mg/m2/day) for the first 30 days. The prevalences of acute and chronic GVHD were 28.1% and 18%, respectively. In a median (IQR) follow-up of 49 (26.5-93.3) months, 60 (27.6%) patients experienced a total of 92 CMV reactivations. Patient group that experienced CMV reactivations was characterized by higher rates of malignant diseases, higher rates of mismatched donors, lower rates of bone marrow as stem cell source, higher acute and chronic GVHD prevalences, and higher grades of acute GVHD. In the group that did not experience CMV reactivation, 2-year overall survival rates were higher and treatment-related mortality rates were lower. This association remained consistent when evaluated among non-malignant patients. However, no significant difference was observed in the malignant diseases.

Conclusion

After an effective prophylaxis, CMV DNA monitoring combined with preemptive treatment have an important role in CMV management. However, the survival rates among patients experiencing CMV reactivation remain lower.