Antimicrobial Stewardship Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Division of Pediatrics Infectious Diseases, Anne and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA.
J Pediatric Infect Dis Soc. 2021 Oct 27;10(9):910-918. doi: 10.1093/jpids/piab041.
Cytomegalovirus (CMV) is a significant source of morbidity and mortality among transplant recipients; the epidemiology is less understood in pediatric hematopoietic cell transplantation (HCT) cohorts. Furthermore, there is a paucity of data related to CMV prophylactic and preemptive strategies.
A single-center retrospective observational cohort of allogeneic HCT recipients at the Children's Hospital of Philadelphia January 1, 2004-December 31, 2017 was constructed. Subjects were followed for 180 days after transplant to determine whether they had CMV infection or disease. Data on antiviral therapy were collected as were outcomes of CMV disease and adverse events (AEs) related to the antiviral therapy.
Between January 2004 and March 2017, 345 allogeneic HCTs in 333 patients undergoing CMV surveillance testing were identified. CMV DNAemia was detected during the 180-day follow-up in 89 (25.8%) HCTs. CMV recipient-positive transplants were most likely to have CMV infection (47%). Infection rates were high for those receiving a CMV-specific prophylaxis regimen (50%). CMV DNAemia progressed to CMV disease 11.2% of the time. Of 224 subjects receiving CMV-specific prophylaxis, 19.2% experienced ≥1 AE. Of 53 receiving preemptive therapy during any CMV DNAemia episode, 32.1% experienced ≥1 AE.
CMV infection is common in pediatric allogeneic HCT recipients. The CMV-specific prophylaxis regimen employed in this cohort did not effectively prevent DNAemia, progression to CMV disease was uncommon, and AEs from prophylaxis and preemptive therapy were frequent. Novel approaches that reduce the impact of CMV on pediatric allogeneic HCT recipients are needed.
巨细胞病毒（CMV）是移植受者发病率和死亡率的重要来源；在儿科造血细胞移植（HCT）队列中，其流行病学了解较少。此外，有关 CMV 预防和抢先治疗策略的数据也很少。
我们构建了费城儿童医院 2004 年 1 月 1 日至 2017 年 12 月 31 日所有异基因 HCT 受者的单中心回顾性观察队列。在移植后 180 天内对受试者进行随访，以确定他们是否患有 CMV 感染或疾病。收集了抗病毒治疗的数据，以及与抗病毒治疗相关的 CMV 疾病和不良事件（AE）的结果。
在 2004 年 1 月至 2017 年 3 月期间，在接受 CMV 监测检测的 333 名患者中，确定了 345 例异基因 HCT。在 180 天的随访期间，89 例（25.8%）HCT 中检测到 CMV DNA 血症。CMV 受体阳性移植最有可能发生 CMV 感染（47%）。接受 CMV 特异性预防方案的感染率很高（50%）。CMV DNA 血症进展为 CMV 疾病的时间为 11.2%。在接受 CMV 特异性预防的 224 名受试者中，19.2%经历了≥1 例 AE。在 53 名在任何 CMV DNA 血症发作期间接受抢先治疗的患者中，32.1%经历了≥1 例 AE。
CMV 感染在儿科异基因 HCT 受者中很常见。在该队列中使用的 CMV 特异性预防方案并未有效预防 DNA 血症，CMV 疾病的进展并不常见，预防和抢先治疗的 AE 很常见。需要寻找减少 CMV 对儿科异基因 HCT 受者影响的新方法。
