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Alexandersson A, Koskenvuo M, Tiderman A, Lääperi M, Huttunen P, Saarinen-Pihkala U, Anttila VJ, Lautenschlager I, Taskinen M. Viral infections and immune reconstitution interaction after pediatric allogenic hematopoietic stem cell transplantation. Infect Dis (Lond) 2019; 51:772-778. [PMID: 31380705 DOI: 10.1080/23744235.2019.1650198] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Viral infections are a major cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Although immune suppression plays a central role, the literature shows conflicting results on interplay between post-transplant immune reconstitution (IR) and viral infections. Methods: We prospectively studied viral infections and IR in 30 pediatric patients undergoing allogenic HSCT, with a follow-up time of 24 months. In total, 1337 blood (CMV, EBV, HHV-6, ADV and BKV) and urine (BKV and JCV) virus samples were analyzed. IR including B-cells (CD19+), T cells (CD3+, CD4+, CD8+) and NK-cells were measured. Clinical outcomes included overall survival (OS), non-relapse mortality (NRM), graft-versus-host disease (GVHD) and occurrence of blood culture positive bacterial infections. Results: We found BKV reactivation to be most frequent, 47% of the children had viremia and 77% viruria. The frequencies of CMV, HHV-6 and adeno viremia were 37%, 37% and 6%, respectively. Viremias beyond 3 months post-HSCT were uncommon. Factors such as GVHD, use of steroids, EBV and CMV infections and pre-transplant irradiation affected IR. No specific viral infection or IR related factor was associated to OS or NRM. Conclusions: Viral infections and IR interact in a bi-directional manner. Accordingly, close follow-up of both IR and viral loads is warranted.
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Affiliation(s)
- Adam Alexandersson
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, New Children's Hospital, Helsinki University Hospital , Helsinki , Finland.,Faculty of Medicine, University of Helsinki , Helsinki , Finland.,New Children's Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital , Helsinki , Finland
| | - Minna Koskenvuo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, New Children's Hospital, Helsinki University Hospital , Helsinki , Finland.,Faculty of Medicine, University of Helsinki , Helsinki , Finland
| | - Anette Tiderman
- Faculty of Medicine, University of Helsinki , Helsinki , Finland
| | - Mitja Lääperi
- New Children's Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital , Helsinki , Finland
| | - Pasi Huttunen
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, New Children's Hospital, Helsinki University Hospital , Helsinki , Finland.,Faculty of Medicine, University of Helsinki , Helsinki , Finland
| | - Ulla Saarinen-Pihkala
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, New Children's Hospital, Helsinki University Hospital , Helsinki , Finland
| | - Veli-Jukka Anttila
- Faculty of Medicine, University of Helsinki , Helsinki , Finland.,Inflammation Center, Helsinki University Hospital , Helsinki , Finland
| | - Irmeli Lautenschlager
- Faculty of Medicine, University of Helsinki , Helsinki , Finland.,Department of Virology and Immunology, Helsinki University Hospital , Helsinki , Finland
| | - Mervi Taskinen
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, New Children's Hospital, Helsinki University Hospital , Helsinki , Finland.,Faculty of Medicine, University of Helsinki , Helsinki , Finland
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