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Clinical characteristics and viral load patterns in children with cytomegalovirus gastrointestinal disease after allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 56, pages 2813–2819 (2021)Cite this article

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Abstract

Cytomegalovirus (CMV) reactivation in allogeneic hematopoietic stem cell transplantation (allo-HSCT) causes significant morbidity and mortality. This study aimed to investigate the clinical characteristics of children diagnosed with CMV GI disease after allo-HSCT. This was a retrospective cohort study of patients <19 years old that underwent allo-HSCT during an 11-year period. Of the 756 patients, 55.5% (n = 420) experienced post-transplant CMV DNAemia, 2.9% (n = 22) were diagnosed with proven CMV GI diseases, and the highest incidence was found in familial mismatched donors (5.6%, P = 0.029). CMV GI disease was diagnosed <100 days of transplant in 68.2% (n = 15/22), and 13.6% (n = 3/22) did not have concurrent CMV DNAemia. Patients were divided into five groups based on the patterns of CMV viremia initiation and duration post-HSCT. At 3 months post-transplant, lower CD4+ (P = 0.006) and CD8+ (P = 0.011) T-cell counts were observed in patients with waxing and waning CMV viral load titers >100 days post-transplant (groups 1–3) compared to those with CMV DNAemia only prior to 100 days post-transplant and those without concurrent CMV DNAemia (groups 4–5). A higher 1-year all-cause mortality was observed in groups 1–3 compared to groups 4–5 (42.8% vs. 0%; P = 0.051). Active surveillance and aggressive management of CMV reactivation is crucial, especially in children with delayed CD4+ and CD8+ T-cell reconstitution after allo-HSCT.

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Fig. 1: Incidence of CMV GI disease by donor type.
Fig. 2: Heat map showing changes in blood CMV viral loads for each of the patients that underwent allo-HSCT in relation to CMV GI disease diagnosis.
Fig. 3: CD4+ and CD8+ T-cell reconstitution.

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Authors and Affiliations

  1. Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Hyun Mi Kang, Seong Koo Kim, In Hyuk Ryu, Jae Wook Lee, Nack-Gyun Chung, Dae Chul Jeong & Bin Cho

  2. Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Hyun Mi Kang & Dong Gun Lee

  3. Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Seong Koo Kim, Jae Wook Lee, Dong Gun Lee, Nack-Gyun Chung & Bin Cho

  4. Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Dong Gun Lee

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Kang, H.M., Kim, S.K., Ryu, I.H. et al. Clinical characteristics and viral load patterns in children with cytomegalovirus gastrointestinal disease after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 56, 2813–2819 (2021). https://doi.org/10.1038/s41409-021-01394-8

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