Lau Calvin E, DiTullio David J, Wilhalme Holly, Bowles LaVette, Moore Theodore B, De Oliveira Satiro N
David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
These authors contributed equally to this work.
J Hematol. 2025 Feb;14(1):1-13. doi: 10.14740/jh1376. Epub 2025 Feb 4.
Pediatric hematopoietic stem cell transplant (pHSCT) patients are at risk for many life-threatening post-transplant complications, notably relapse, graft-versus-host disease (GvHD), and infection.
This retrospective study reviewed 10 years of pHSCT at a single institution, assessing for risk factors for post-transplantation viral infections (herpes simplex virus (HSV), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpes virus 6 (HHV6), adenovirus (ADNV), and human polyoma virus 1 (BK virus)), and characterizing adverse infectious outcomes.
Overall, 139 patients received 151 transplants. With respect to graft source: 73 (48.3%) were bone marrow, 67 (44.4%) umbilical cord blood (UCB), and 11 (7.2%) peripheral blood stem cells (PBSCs). Forty-one deaths occurred, for an overall mortality rate of 29.5%. The overall incidence of post-transplant viral infections was 47.7% (n = 72). Incidence of post-transplant infection varied by virus type: 3.97% HSV, 0.67% VZV, 3.97% EBV, 24.5% CMV, 14.5% HHV6, 12.6% ADNV, and 12.6% BK virus. Viral encephalitis, though relatively uncommon, was primarily caused by HHV6 and more common in UCB transplants. Overall, cell source and donor source were identified with statistically significant correlation to both risk of infection and mortality.
Post-transplant viral infection remains as a serious adverse event in pediatric patients, and thus prospective studies should be performed to implement early intervention and more aggressive treatment in select high-risk patients. More studies specifically addressing infection risks in cord blood transplants and risk factors for post-transplant viral encephalitis are warranted.
儿科造血干细胞移植（pHSCT）患者面临许多危及生命的移植后并发症风险，尤其是复发、移植物抗宿主病（GvHD）和感染。
这项回顾性研究对一家机构10年的pHSCT进行了评估，分析移植后病毒感染（单纯疱疹病毒（HSV）、水痘带状疱疹病毒（VZV）、爱泼斯坦-巴尔病毒（EBV）、巨细胞病毒（CMV）、人类疱疹病毒6型（HHV6）、腺病毒（ADNV）和人类多瘤病毒1型（BK病毒））的危险因素，并对不良感染结局进行特征描述。
总体而言，139例患者接受了151次移植。关于移植物来源：73例（48.3%）为骨髓，67例（44.4%）为脐带血（UCB），11例（7.2%）为外周血干细胞（PBSC）。41例患者死亡，总死亡率为29.5%。移植后病毒感染的总体发生率为47.7%（n = 72）。移植后感染发生率因病毒类型而异：HSV为3.97%，VZV为0.67%，EBV为3.97%，CMV为24.5%，HHV6为14.5%，ADNV为12.6%，BK病毒为12.6%。病毒性脑炎虽然相对少见，但主要由HHV6引起，在UCB移植中更常见。总体而言，细胞来源和供体来源与感染风险和死亡率均存在统计学显著相关性。
移植后病毒感染仍是儿科患者严重的不良事件，因此应开展前瞻性研究，以便对选定的高危患者实施早期干预和更积极的治疗。有必要开展更多专门针对脐带血移植感染风险和移植后病毒性脑炎危险因素的研究。
