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Kampouri E, Little JS, Crocchiolo R, Hill JA. Human herpesvirus-6, HHV-8 and parvovirus B19 after allogeneic hematopoietic cell transplant: the lesser-known viral complications. Curr Opin Infect Dis 2024; 37:245-253. [PMID: 38726832 DOI: 10.1097/qco.0000000000001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW Viral infections continue to burden allogeneic hematopoietic cell transplant (HCT) recipients. We review the epidemiology, diagnosis, and management of human herpesvirus (HHV)-6, HHV-8 and parvovirus B19 following HCT. RECENT FINDINGS Advances in HCT practices significantly improved outcomes but impact viral epidemiology: post-transplant cyclophosphamide for graft-versus-host disease prevention increases HHV-6 reactivation risk while the impact of letermovir for CMV prophylaxis - and resulting decrease in broad-spectrum antivirals - is more complex. Beyond the well established HHV-6 encephalitis, recent evidence implicates HHV-6 in pneumonitis. Novel less toxic therapeutic approaches (brincidofovir, virus-specific T-cells) may enable preventive strategies in the future. HHV-8 is the causal agent of Kaposi's sarcoma, which is only sporadically reported after HCT, but other manifestations are possible and not well elucidated. Parvovirus B19 can cause severe disease post-HCT, frequently manifesting with anemia, but can also be easily overlooked due to lack of routine screening and ambiguity of manifestations. SUMMARY Studies should establish the contemporary epidemiology of HHV-6, and other more insidious viruses, such as HHV-8 and parvovirus B19 following HCT and should encompass novel cellular therapies. Standardized and readily available diagnostic methods are key to elucidate epidemiology and optimize preventive and therapeutic strategies to mitigate the burden of infection.
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Affiliation(s)
- Eleftheria Kampouri
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jessica S Little
- Dana-Farber Cancer Institute
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Roberto Crocchiolo
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Joshua A Hill
- Vaccine and Infectious Disease Division
- Clinical Research Division, Fred Hutchinson Cancer Center
- Department of Medicine, University of Washington, Seattle, Washington, USA
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Jiménez-Hernández E, Núñez-Enriquez JC, Arellano-Galindo J, de los Angeles Del Campo-Martínez M, Reynoso-Arenas PV, Reyes-López A, Delgado-Gaytan AV, Del Socorro Méndez-Tovar M, Marín-Palomares T, Dueñas-Gonzalez MT, Ortíz-Fernández A, Montero-Ponce I, Espinosa-Hernández LE, Núñez-Villegas NN, Pérez-Casillas R, Sánchez-Jara B, García-Soto A, Herver-Olivares AN, Jaimes-Reyes EZ, Tiznado-García HM, Martínez-Villegas O, Valdez-Garibay B, Del Rocío Loza-Santiaguillo P, García-Jiménez X, Ortíz-Torres G, Fernández-Castillo GJ, Aguilar-Olivares DM, Díaz-Padilla LA, Noya-Rodríguez MA, García-Jiménez M, Mejía-Aranguré JM. Infections and risk factors for infection-related mortality after pediatric allogeneic hematopoietic stem cell transplantation in Mexico: A single center retrospective study. PLoS One 2023; 18:e0284628. [PMID: 37773955 PMCID: PMC10540957 DOI: 10.1371/journal.pone.0284628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/04/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE To identify the type of infections and risk factors for infection-related mortality (IRM) after allogeneic hematopoietic stem cell transplantation (HSCT). METHODS Retrospective cohort study of patients <16 years of age treated in 2010-2019 was conducted. Unadjusted hazard ratios (HR) and adjusted hazard ratios (aHR) with 95% confidence intervals (95% CIs) were estimated using Cox regression. Cumulative incidence was calculated. RESULTS Data for 99 pediatric patients were analyzed. The myeloablative conditioning was the most used regimen (78.8%) and the hematopoietic stem cell source was predominantly peripheral blood (80.8%). Primary graft failure occurred in 19.2% of patients. Frequency of acute graft-versus-host disease was 46.5%. Total of 136 infectious events was recorded, the most common of which were bacterial (76.4%) followed by viral infection (15.5%) and then fungal infection (8.1%). The best predictors for infection subtypes where the following: a) for bacterial infection (the age groups of 10.1-15 years: aHR = 3.33; 95% CI: 1.62-6.85 and. >15 years: aHR = 3.34; 95% CI: 1.18-9.45); b) for viral infection (graft versus host disease: aHR = 5.36; 95% CI: 1.62-17.68), however, for fungal infection statistically significant predictors were not identified. Related mortality was 30% (n = 12). Increased risk for infection-related mortality was observed in patients with unrelated donor and umbilical cord stem cells recipients (HR = 3.12; 95% CI: 1.00-9.85). CONCLUSIONS Frequencies of infections and infection-related mortality appear to be similar to those reported. Unrelated donors and stem cells from umbilical cord recipients were associated with a high risk of mortality.
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Affiliation(s)
- Elva Jiménez-Hernández
- Servicio de Hematología Pediátrica y Unidad de Trasplante de Médula Osea, Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional (CMN)” La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | - Juan Carlos Núñez-Enriquez
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE, Hospital de Pediatría, CMN “Siglo XXI”, IMSS, Mexico City, Mexico
| | - José Arellano-Galindo
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - María de los Angeles Del Campo-Martínez
- Servicio de Hematología Pediátrica y Unidad de Trasplante de Médula Osea, Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional (CMN)” La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | | | - Alfonso Reyes-López
- Centro de Estudios Económicos y Sociales en Salud, Hospital Infantil de México Federico Gómez, de la Secretaría de Salud, México City, Mexico
| | | | | | - Teresa Marín-Palomares
- Servicio de Hematología Pediátrica y Unidad de Trasplante de Médula Osea, Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional (CMN)” La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - María Teresa Dueñas-Gonzalez
- Servicio de Hematología Pediátrica y Unidad de Trasplante de Médula Osea, Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional (CMN)” La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Antonio Ortíz-Fernández
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Inés Montero-Ponce
- Servicio de Hematología Pediátrica y Unidad de Trasplante de Médula Osea, Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional (CMN)” La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Laura Eugenia Espinosa-Hernández
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Nora Nancy Núñez-Villegas
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Ruy Pérez-Casillas
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Berenice Sánchez-Jara
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Angel García-Soto
- Servicio de Hematología Pediátrica y Unidad de Trasplante de Médula Osea, Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional (CMN)” La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Annecy Nelly Herver-Olivares
- Servicio de Hematología Pediátrica y Unidad de Trasplante de Médula Osea, Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional (CMN)” La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Ethel Zulie Jaimes-Reyes
- Centro Estatal de Cancerología, “Dr. Miguel Dorantes-Mesa”, Secretaría de Salud, Xalapa Veracruz, México
| | - Hector Manuel Tiznado-García
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Octavio Martínez-Villegas
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Betzayda Valdez-Garibay
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Paloma Del Rocío Loza-Santiaguillo
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Xochiketzalli García-Jiménez
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
- Hospital Pediátrico Coyoacán, Secretaría de Salud Gobierno de la Ciudad de México, Mexico City, México
| | - Guadalupe Ortíz-Torres
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Gabriela Jazmin Fernández-Castillo
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Dulce María Aguilar-Olivares
- Servicio de Hematología Pediátrica y Unidad de Trasplante de Médula Osea, Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional (CMN)” La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Luis Alejandro Díaz-Padilla
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Mario Alberto Noya-Rodríguez
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Mariana García-Jiménez
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Juan Manuel Mejía-Aranguré
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica, Mexico City, Mexico
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE, Hospital de Pediatría, CMN “Siglo XXI”, IMSS, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
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Wang X, Lu Y, Li H, Ma Z, Hong J, Wang C. Analysis of Clinical Characteristics of Patients with Recurrent Cytomegalovirus Retinitis after Hematopoietic Stem Cell Transplantation. J Pers Med 2023; 13:jpm13040639. [PMID: 37109025 PMCID: PMC10142787 DOI: 10.3390/jpm13040639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE To analyze and summarize the clinical and imaging characteristics of patients with cytomegalovirus retinitis (CMVR) relapse after hematopoietic stem cell transplantation (HSCT). METHODS This retrospective case series study recruited patients with CMVR after HSCT. The study compared the patients with stable lesions and CMV-negative aqueous humor after treatment with those with relapse lesions and a CMV DNA load in aqueous humor which had increased again after treatment. The observation indexes were basic clinical information, best-corrected visual acuity, wide-angle fundus photography, optical coherence tomography (OCT), blood CD4+ T lymphocyte count, and aqueous humor CMV load of the patients. We summarized the data and statistically analyzed the differences between the relapse and non-relapse groups, as well as the correlations of the observed indicators. RESULTS The study recruited 52 patients with CMVR (82 eyes) after HSCT, of whom 11 patients (15 eyes) had recurrence after treatment (21.2%). The recurrence interval was 6.4 ± 4.9 months. The final best-corrected visual acuity of recurrent patients was 0.3 ± 0.3. The number of CD4+ T lymphocytes in recurrence patients at the time of onset was 126.7 ± 80.2/mm3. The median CMV DNA load detected in aqueous humor at the time of recurrence was 8.63 × 103 copies/mL. There was a significant difference in the CD4+ T lymphocyte count between the recurrence and the non-recurrence groups at onset. The onset of visual acuity in recurrence patients was significantly correlated with final visual acuity and recurrence lesion area. The fundus of recurred CMVR showed increased marginal activity of the original stable lesion. Concurrently, yellow-white new lesions appeared around the stable, atrophic, and necrotic lesions. OCT showed new diffuse hyperreflexic lesions in the retinal neuroepithelial layer near the old lesions. Inflammatory punctate hyperreflexes were observed in the vitreous, with vitreous liquefaction and contraction. CONCLUSION This study suggests that the clinical features, fundus manifestations, and imaging features of CMVR recurrence after HSCT are different from those at the initial onset. Patients should be closely followed up after their condition is stable to be alert for CMVR recurrence.
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Affiliation(s)
- Xiaona Wang
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Yao Lu
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Haiping Li
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Zhizhong Ma
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Jing Hong
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Changguan Wang
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
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Mo W, Chen X, Zhang X, Wang S, Li L, Zhang Y. The Potential Association of Delayed T Lymphocyte Reconstitution Within Six Months Post-Transplantation With the Risk of Cytomegalovirus Retinitis in Severe Aplastic Anemia Recipients. Front Cell Infect Microbiol 2022; 12:900154. [PMID: 35694535 PMCID: PMC9174513 DOI: 10.3389/fcimb.2022.900154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Delayed immune reconstitution after allogeneic hematopoietic stem cell transplantation (HSCT) is significantly associated with cytomegalovirus (CMV) infection. The aim of this study was to observe the recovery trend of peripheral lymphocyte subsets and immunoglobulins in HSCT recipients who developed CMV retinitis (CMVR). Methods We identified 37 CMVR cases and 303 non-CMVR controls in this case-control study from a database of 404 consecutive severe aplastic anemia patients who received allogeneic HSCT at a single center between 2015 and 2020. We analyzed the transplant outcomes and immune reconstitution principles with a focus on lymphocyte CD series and immunoglobulin series within the first year post-HSCT. Results Thirty-seven patients (55 eyes) were diagnosed with CMVR, with a mean onset time of 155 days post-HSCT. Among the 37 patients, one never had CMV detected in his blood but had a high CMV load in his intraocular fluid at the time of CMVR diagnosis. In the controls, 195 had CMV viremia and 108 did not. Compared with controls, CMVR cases had a longer duration of CMV viremia and a higher peak number of CMV load. T lymphocyte subsets including CD3, CD4 and CD8 were significantly lower in CMVR cases within six months after HSCT (all p < 0.05). Immunoglobulins also showed a slower recovery trend in CMVR cases. The recovery of B lymphocytes and natural killer cells exhibited no significant differences between the two groups. Conclusions It is not enough to develop fundus screening strategies by merely relying on the CMV serostatus of recipients. Dynamic and continuous monitoring of T lymphocyte subsets, especially within six months post-HSCT, as well as serum immunoglobulin levels, can provide assistance with screening program of CMVR in HSCT recipients with severe aplastic anemia.
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Affiliation(s)
- Wenjian Mo
- Department of Hematology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xiangting Chen
- Department of Ophthalmology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xu Zhang
- Department of Ophthalmology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Shunqing Wang
- Department of Hematology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Ling Li
- Department of Biology, University of North Dakota, Grand Forks, ND, United States
| | - Yuehong Zhang
- Department of Ophthalmology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- *Correspondence: Yuehong Zhang,
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Camacho-Bydume C, Mauguen A, Rodriguez-Sanchez MI, Klein E, Kernan NA, Prockop S, Boelens JJ, Papanicolaou GA, Cancio M. Time to initiation of pre-emptive therapy for cytomegalovirus impacts overall survival in pediatric hematopoietic stem cell transplant recipients. Cytotherapy 2022; 24:428-436. [PMID: 35042670 PMCID: PMC10019069 DOI: 10.1016/j.jcyt.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AIMS Cytomegalovirus (CMV) reactivation is a significant complication following allogeneic hematopoietic stem cell transplant (HSCT) and affects upwards of 40% of pediatric HSCT patients. Pre-emptive therapy remains the only effective treatment strategy available for pediatric patients following CMV reactivation. Little is known about how the timing of induction treatment following CMV reactivation impacts outcomes in pediatric patients, especially following ex vivo T-cell-depleted (TCD) HSCT. METHODS The authors evaluated how the timing of induction treatment after CMV reactivation impacts overall survival (OS) and CMV disease in pediatric patients undergoing TCD HSCT at a single institution. The authors retrospectively analyzed patients treated on the pediatric service who received an initial ex vivo TCD HSCT at Memorial Sloan Kettering Cancer Center (MSKCC) from January 2010 to June 2018. CMV reactivation was defined as ≥1 CMV polymerase chain reaction >500 copies/mL in whole blood or >137 IU/mL in plasma within the first 180 days after allogeneic HSCT. To analyze the impact of the timing of induction treatment, the authors' primary study outcome was OS and secondary outcome was CMV disease. RESULTS A total of 169 patients who underwent an initial allogeneic TCD HSCT on the pediatric service at MSKCC from January 2010 to June 2018 were included in the analysis. Thirty-seven (22%) patients reactivated CMV during the first 180 days following HSCT. Of those patients who reactivated CMV, CMV donor/recipient (D/R) serostatus was as follows: D+/R+ n = 28 (76%) and D-/R+ n = 9 (24%). There was no CMV reactivation observed among recipients who were CMV-seronegative irrespective of donor serostatus. In those patients who reactivated CMV, the median time from HSCT to CMV reactivation was 24 days (interquartile range, 20-31). Eleven patients ultimately developed CMV disease in addition to CMV viremia, whereas the remaining patients had only CMV viremia. The cumulative incidence of CMV reactivation at 60 days was 45.2% (95% confidence interval [CI], 32.8-57.5) in the D+/R+ subgroup and 31% (95% CI, 14.2-47.9) in the D-/R+ subgroup. For those patients who reactivated CMV, 30 (81%) received induction treatment with ganciclovir or foscarnet. To analyze the impact of the timing of induction treatment on clinical outcomes, the authors restricted the analysis to those patients who reactivated CMV and received induction treatment (n = 30). The timing of induction treatment was significantly associated with OS, with optimal timing of initiation within a week of CMV reactivation (P = 0.02). There was no significant impact on the timing of induction treatment and risk of CMV disease (P = 0.30). CONCLUSIONS In ex vivo TCD HSCT in pediatric patients, early initiation of induction treatment after CMV reactivation is associated with improved OS.
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Affiliation(s)
- Christine Camacho-Bydume
- General Oncology Service, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Audrey Mauguen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - M Irene Rodriguez-Sanchez
- Pediatric Translational Medicine Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elizabeth Klein
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nancy A Kernan
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Susan Prockop
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jaap Jan Boelens
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Genovefa A Papanicolaou
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Maria Cancio
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
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Zhang LY, Liu F, Chen X, Zhang XY, Ren YY, Zhang RR, Yang WY, Guo Y. [The hematological diversity of human parvovirus B19 infection after allo-hematopoietic stem cell transplantation in pediatric patients]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:654-659. [PMID: 34547871 PMCID: PMC8501274 DOI: 10.3760/cma.j.issn.0253-2727.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
目的 探讨异基因造血干细胞移植(allo-HSCT)患儿造血重建后人类细小病毒B19(HPV-B19)感染的血液学表现。 方法 对9例allo-HSCT后合并HPV-B19感染的患儿进行回顾性分析。 结果 9例患儿占同期接受allo-HSCT患儿的8.04%(9/112),男8例,女1例,中位年龄9(3~13)岁,均采取清髓性预处理方案。HPV-B19感染中位时间为移植后61(36~114)d。allo-HSCT并发HPV-B19感染患儿血液学表现具有异质性,9例患儿以血红蛋白伴网织红细胞下降为主要特点,7 d内网织红细胞比例、绝对值下降幅度中位数分别为90.4%(24.7%~98.7%)、90.7%(18.6%~99.0%)。除常见红系造血停滞表现外,allo-HSCT后合并HPV-B19感染的患儿还具有非红系的血象及骨髓变化:5例患儿外周血出现中性粒细胞下降,但骨髓涂片未见粒系增生受抑;6例患儿骨髓涂片查见巨核系增生减低,其中5例患儿外周血血小板下降。同时,allo-HSCT造血重建后合并HPV-B19感染的患儿骨髓红系受抑并非必要表现,9例患儿虽然均出现血红蛋白下降,但仅5例患儿骨髓红系增生减低。 结论 血液病患儿allo-HSCT造血重建后合并HPV-B19感染的血液学表现具有异质性,血红蛋白伴网织红细胞下降对HPV-B19感染早期诊断可能具有重要意义。
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Affiliation(s)
- L Y Zhang
- State Key Laboratory of Experimental Hematology; National Clinical Research Center for Blood Diseases; Children's Blood Disease Diagnosis and Treatment Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - F Liu
- State Key Laboratory of Experimental Hematology; National Clinical Research Center for Blood Diseases; Children's Blood Disease Diagnosis and Treatment Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - X Chen
- State Key Laboratory of Experimental Hematology; National Clinical Research Center for Blood Diseases; Children's Blood Disease Diagnosis and Treatment Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - X Y Zhang
- State Key Laboratory of Experimental Hematology; National Clinical Research Center for Blood Diseases; Children's Blood Disease Diagnosis and Treatment Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Y Y Ren
- State Key Laboratory of Experimental Hematology; National Clinical Research Center for Blood Diseases; Children's Blood Disease Diagnosis and Treatment Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - R R Zhang
- State Key Laboratory of Experimental Hematology; National Clinical Research Center for Blood Diseases; Children's Blood Disease Diagnosis and Treatment Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - W Y Yang
- State Key Laboratory of Experimental Hematology; National Clinical Research Center for Blood Diseases; Children's Blood Disease Diagnosis and Treatment Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Y Guo
- State Key Laboratory of Experimental Hematology; National Clinical Research Center for Blood Diseases; Children's Blood Disease Diagnosis and Treatment Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
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7
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[Pediatric expert consensus on the application of intravenous immunoglobulin in children with hematological/neoplastic diseases]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23. [PMID: 33840401 PMCID: PMC8050546 DOI: 10.7499/j.issn.1008-8830.2101174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Intravenous immunoglobulin (IVIG) has been widely used in chemotherapy for hematological malignancies, targeted therapy, and hematopoietic stem cell transplantation; however, there are still no available guidelines or consensus statements on the application of IVIG in pediatric hematological/neoplastic diseases at present in China and overseas. This consensus is developed based on the research advances in the application of IVIG in pediatric hematological/neoplastic diseases across the world and provides detailed recommendations for the clinical application of IVIG in pediatric hematological/neoplastic diseases and the prevention and treatment of related adverse reactions.
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8
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Factors Associated with Post-Transplant Active Epstein-Barr Virus Infection and Lymphoproliferative Disease in Hematopoietic Stem Cell Transplant Recipients: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2021; 9:vaccines9030288. [PMID: 33808928 PMCID: PMC8003684 DOI: 10.3390/vaccines9030288] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 12/29/2022] Open
Abstract
This systematic review was undertaken to identify risk factors associated with post-transplant Epstein–Barr virus (EBV) active infection and post-transplant lymphoproliferative disease (PTLD) in pediatric and adult recipients of hematopoietic stem cell transplants (HSCT). A literature search was conducted in PubMed and EMBASE to identify studies published until 30 June 2020. Descriptive information was extracted for each individual study, and data were compiled for individual risk factors, including, when possible, relative risks with 95% confidence intervals and/or p-values. Meta-analyses were planned when possible. The methodological quality and potential for bias of included studies were also evaluated. Of the 3362 titles retrieved, 77 were included (62 for EBV infection and 22 for PTLD). The overall quality of the studies was strong. Several risk factors were explored in these studies, but few statistically significant associations were identified. The use of anti-thymocyte globulin (ATG) was identified as the most important risk factor positively associated with post-transplant active EBV infection and with PTLD. The pooled relative risks obtained using the random-effect model were 5.26 (95% CI: 2.92–9.45) and 4.17 (95% CI: 2.61–6.68) for the association between ATG and post-transplant EBV infection and PTLD, respectively. Other risk factors for EBV and PTLD were found in the included studies, such as graft-versus-host disease, type of conditioning regimen or type of donor, but results are conflicting. In conclusion, the results of this systematic review indicate that ATG increases the risk of EBV infection and PTLD, but the link with all other factors is either nonexistent or much less convincing.
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9
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Gasior M, Ferreras C, de Paz R, Bueno D, Mozo Y, Sisinni L, Canizales JT, González B, Olivas-Mazón R, Marcos A, Romero AB, Constanzo A, Mirones I, Fernández-Arroyo A, Balas A, Vicario JL, Escudero A, Yuste VJ, Pérez-Martínez A. The role of early natural killer cell adoptive infusion before engraftment in protecting against human herpesvirus-6B encephalitis after naïve T-cell-depleted allogeneic stem cell transplantation. Transfusion 2021; 61:1505-1517. [PMID: 33713461 DOI: 10.1111/trf.16354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/16/2021] [Accepted: 01/17/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Naïve T-cell-depleted grafts have been employed as an ex vivo T-cell depletion (TCD) platform to prevent graft-versus-host disease (GvHD) and improve immune reconstitution by providing rapid donor memory T-cell reconstitution after allogenic hematopoietic stem cell transplantation (allo-HSCT). CD45RA- memory T cells confer protection against viruses such as cytomegalovirus, Epstein-Barr virus, and adenovirus; however, reports have shown an unexpectedly high incidence of human herpesvirus (HHV)-6B encephalitis among pediatric allo-HSCT patients. METHODS We report the first 18 consecutive allo-HSCT, 16 haplo-HSCT, and two human leukocyte antigen-matched related donors implanted with naïve TCD grafts. All donors were administered three cell products: first, a CD34+ stem cell product; second, a CD45RA+ TCD graft, followed by an adoptive natural killer (NK) cell infusion within 10 days after HSCT. The study's primary endpoint was the incidence of HHV-6B encephalitis. RESULTS Engraftment was achieved in 94.5% of cases; 2-year overall survival, event-free survival, and GvHD/relapse-free survival were 87.2% (95% CI 78.6-95.8), 67.3% (95% CI 53.1-81.5), and 64% (95% CI 50.5-78.1), respectively. HHV-6B reactivation occurred in 7 of the haplo-HSCT patients, six of who received a cell infusion with an NK/CD4 ratio <2. None of the patients developed encephalitis. CONCLUSIONS In this clinical study, we show that early adoptive NK cell infusion after a 45RA+ TCD allo-HSCT graft is safe and can prevent HHV-6B encephalitis. We recommend infusing adoptive NK cells after allo-HSCT using CD45RA+ TCD grafts.
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Affiliation(s)
- Mercedes Gasior
- Hematology Department, La Paz University Hospital, Madrid, Spain
| | - Cristina Ferreras
- Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
| | - Raquel de Paz
- Hematology Department, La Paz University Hospital, Madrid, Spain
| | - David Bueno
- Pediatric Onco-Hematology Department, La Paz University Hospital, Madrid, Spain
| | - Yasmina Mozo
- Pediatric Onco-Hematology Department, La Paz University Hospital, Madrid, Spain
| | - Luisa Sisinni
- Pediatric Onco-Hematology Department, La Paz University Hospital, Madrid, Spain
| | | | - Berta González
- Pediatric Onco-Hematology Department, La Paz University Hospital, Madrid, Spain
| | - Raquel Olivas-Mazón
- Pediatric Onco-Hematology Department, La Paz University Hospital, Madrid, Spain
| | - Antonio Marcos
- Hematology Department, La Paz University Hospital, Madrid, Spain
| | - Ana Belén Romero
- Hematology Department, La Paz University Hospital, Madrid, Spain
| | - Aída Constanzo
- Hematology Department, La Paz University Hospital, Madrid, Spain
| | - Isabel Mirones
- Pediatric Onco-Hematology Department, La Paz University Hospital, Madrid, Spain
| | | | - Antonio Balas
- Histocompatibility and HLA Typing Lab. Transfusion Center of Madrid, Madrid, Spain
| | - Jose Luis Vicario
- Histocompatibility and HLA Typing Lab. Transfusion Center of Madrid, Madrid, Spain
| | - Adela Escudero
- Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
| | | | - Antonio Pérez-Martínez
- Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain.,Pediatric Onco-Hematology Department, La Paz University Hospital, Madrid, Spain.,Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
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10
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Huang Y, Han M, Yang D, Zhang R, Ma Q, Pang A, Zhai W, He Y, Wei J, Jiang E, Feng S, Zhang L. Comparative Study of Mizoribine and Mycophenolate Mofetil Combined with a Calcineurin Inhibitor-Based Immunosuppressive Regimen in Patients with Alternative Donor Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2020; 26:1663-1669. [DOI: 10.1016/j.bbmt.2020.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 11/30/2022]
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11
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Beyond Cytomegalovirus and Epstein-Barr Virus: a Review of Viruses Composing the Blood Virome of Solid Organ Transplant and Hematopoietic Stem Cell Transplant Recipients. Clin Microbiol Rev 2020; 33:33/4/e00027-20. [PMID: 32847820 DOI: 10.1128/cmr.00027-20] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Viral primary infections and reactivations are common complications in patients after solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) and are associated with high morbidity and mortality. Among these patients, viral infections are frequently associated with viremia. Beyond the usual well-known viruses that are part of the routine clinical management of transplant recipients, numerous other viral signatures or genomes can be identified in the blood of these patients. The identification of novel viral species and variants by metagenomic next-generation sequencing has opened up a new field of investigation and new paradigms. Thus, there is a need to thoroughly describe the state of knowledge in this field with a review of all viral infections that should be scrutinized in high-risk populations. Here, we review the eukaryotic DNA and RNA viruses identified in blood, plasma, or serum samples of pediatric and adult SOT/HSCT recipients and the prevalence of their detection, with a particular focus on recently identified viruses and those for which their potential association with disease remains to be investigated, such as members of the Polyomaviridae, Anelloviridae, Flaviviridae, and Astroviridae families. Current knowledge of the clinical significance of these viral infections with associated viremia among transplant recipients is also discussed. To ensure a comprehensive description in these two populations, individuals described as healthy (mostly blood donors) are considered for comparative purposes. The list of viruses that should be on the clinicians' radar is certainly incomplete and will expand, but the challenge is to identify those of possible clinical significance.
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12
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Naik S, Vasileiou S, Aguayo-Hiraldo P, Mukhi S, Sasa G, Martinez C, Krance RA, Gottschalk S, Leen A. Toward Functional Immune Monitoring in Allogeneic Stem Cell Transplant Recipients. Biol Blood Marrow Transplant 2020; 26:911-919. [PMID: 31927102 DOI: 10.1016/j.bbmt.2020.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 12/28/2022]
Abstract
Serious viral infections, due to delayed immune reconstitution, are a leading cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Thus, many transplant centers prospectively track cellular immune recovery by evaluating absolute cell numbers and the phenotypic profile of reconstituting T cell subsets to identify individuals who are at highest risk of infection. Conventional assessments, however, fail to measure either the antigen specificity or functional capacity of reconstituting cells-both factors that correlate with endogenous antiviral protection. In this pilot study, we sought to address this limitation by prospectively investigating the tempo of endogenous immune reconstitution in a cohort of 23 pediatric HSCT patients using both quantitative (flow cytometry) and qualitative (IFNγ ELISpot) measures, which we correlated with either the presence or absence of infections associated with cytomegalovirus, adenovirus, Epstein-Barr virus, BK virus, human herpes virus 6, respiratory syncytial virus, parainfluenza, influenza, and human metapneumovirus. We present data spanning 12 months post-transplant demonstrating the influence of conditioning on immune recovery and highlighting the differential impact of active viral replication on the quantity and quality of reconstituting cells. Judicious use of standard (phenotypic) and novel (functional) monitoring strategies can help guide the clinical care and personalized management of allogenic HSCT recipients with infections.
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Affiliation(s)
- Swati Naik
- Center for Cell and Gene Therapy, Texas Children's Hospital, Baylor College of Medicine, Houston Methodist Hospital, Houston, Texas; Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; Department of Pediatrics, and Medicine Baylor College of Medicine, Houston, Texas.
| | - Spyridoula Vasileiou
- Center for Cell and Gene Therapy, Texas Children's Hospital, Baylor College of Medicine, Houston Methodist Hospital, Houston, Texas; Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Paibel Aguayo-Hiraldo
- Center for Cell and Gene Therapy, Texas Children's Hospital, Baylor College of Medicine, Houston Methodist Hospital, Houston, Texas; Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; Department of Pediatrics, and Medicine Baylor College of Medicine, Houston, Texas
| | - Shivani Mukhi
- Center for Cell and Gene Therapy, Texas Children's Hospital, Baylor College of Medicine, Houston Methodist Hospital, Houston, Texas; Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Ghadir Sasa
- Center for Cell and Gene Therapy, Texas Children's Hospital, Baylor College of Medicine, Houston Methodist Hospital, Houston, Texas; Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; Department of Pediatrics, and Medicine Baylor College of Medicine, Houston, Texas
| | - Caridad Martinez
- Center for Cell and Gene Therapy, Texas Children's Hospital, Baylor College of Medicine, Houston Methodist Hospital, Houston, Texas; Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; Department of Pediatrics, and Medicine Baylor College of Medicine, Houston, Texas
| | - Robert A Krance
- Center for Cell and Gene Therapy, Texas Children's Hospital, Baylor College of Medicine, Houston Methodist Hospital, Houston, Texas; Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; Department of Pediatrics, and Medicine Baylor College of Medicine, Houston, Texas
| | - Stephen Gottschalk
- Center for Cell and Gene Therapy, Texas Children's Hospital, Baylor College of Medicine, Houston Methodist Hospital, Houston, Texas; Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; Department of Pediatrics, and Medicine Baylor College of Medicine, Houston, Texas
| | - Ann Leen
- Center for Cell and Gene Therapy, Texas Children's Hospital, Baylor College of Medicine, Houston Methodist Hospital, Houston, Texas; Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; Department of Pediatrics, and Medicine Baylor College of Medicine, Houston, Texas
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13
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Ottaviano G, Lucchini G, Breuer J, Furtado-Silva JM, Lazareva A, Ciocarlie O, Elfeky R, Rao K, Amrolia PJ, Veys P, Chiesa R. Delaying haematopoietic stem cell transplantation in children with viral respiratory infections reduces transplant-related mortality. Br J Haematol 2019; 188:560-569. [PMID: 31566733 PMCID: PMC7161889 DOI: 10.1111/bjh.16216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/31/2019] [Indexed: 01/05/2023]
Abstract
Viral respiratory infections (VRIs) contribute to the morbidity and transplant‐related mortality (TRM) after allogeneic haematopoietic stem cell transplantation (HSCT) and strategies to prevent and treat VRIs are warranted. We monitored VRIs before and after transplant in children undergoing allogeneic HSCT with nasopharyngeal aspirates (NPA) and assessed the impact on clinical outcome. Between 2007 and 2017, 585 children underwent 620 allogeneic HSCT procedures. Out of 75 patients with a positive NPA screen (12%), transplant was delayed in 25 cases (33%), while 53 children started conditioning with a VRI. Patients undergoing HSCT with a positive NPA screen had a significantly lower overall survival (54% vs. 79%) and increased TRM (26% vs. 7%) compared to patients with a negative NPA. Patients with a positive NPA who delayed transplant and cleared the virus before conditioning had improved overall survival (90%) and lower TRM (5%). Pre‐HSCT positive NPA was the only significant risk factor for progression to a lower respiratory tract infection and was a major risk factor for TRM. Transplant delay, whenever feasible, in case of a positive NPA screen for VRIs can positively impact on survival of children undergoing HSCT.
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Affiliation(s)
- Giorgio Ottaviano
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Paediatrics, University of Milano-Bicocca, San Gerardo Hospital/Fondazione MBBM, Monza, Italy
| | - Giovanna Lucchini
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Judith Breuer
- Department of Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Division of Infection and Immunity, University College London, London, UK
| | - Juliana M Furtado-Silva
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Arina Lazareva
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Oana Ciocarlie
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Reem Elfeky
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kanchan Rao
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Persis J Amrolia
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Paul Veys
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Robert Chiesa
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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14
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Obeid KM. Infections with DNA Viruses, Adenovirus, Polyomaviruses, and Parvovirus B19 in Hematopoietic Stem Cell Transplant Recipients and Patients with Hematologic Malignancies. Infect Dis Clin North Am 2019; 33:501-521. [PMID: 30940465 DOI: 10.1016/j.idc.2019.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Infections due to adenovirus, polyomaviruses (BK and JC viruses), and parvovirus B19 may not be as common as infections due to other DNA viruses, such as cytomegalovirus in patients with hematological malignancies and the recipients of hematopoietic stem cell transplantation. However, these infections may result in life-threatening diseases that significantly impact patients' recovery, morbidity, and mortality. Treating physicians should be aware of the diseases associated with these viruses, the patient populations at increased risk for complications due to these infections, and the available diagnostic and therapeutic approaches.
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Affiliation(s)
- Karam M Obeid
- Division of Infectious Diseases and International Medicine, University of Minnesota, 420 Delaware Street SE, MMC250, Minneapolis, MN 55455, USA.
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15
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Melendez-Munoz R, Marchalik R, Jerussi T, Dimitrova D, Nussenblatt V, Beri A, Rai K, Wilder JS, Barrett AJ, Battiwalla M, Childs RW, Fitzhugh CD, Fowler DH, Fry TJ, Gress RE, Hsieh MM, Ito S, Kang EM, Pavletic SZ, Shah NN, Tisdale JF, Gea-Banacloche J, Kanakry CG, Kanakry JA. Cytomegalovirus Infection Incidence and Risk Factors Across Diverse Hematopoietic Cell Transplantation Platforms Using a Standardized Monitoring and Treatment Approach: A Comprehensive Evaluation from a Single Institution. Biol Blood Marrow Transplant 2019; 25:577-586. [PMID: 30342913 PMCID: PMC6445771 DOI: 10.1016/j.bbmt.2018.10.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/11/2018] [Indexed: 12/18/2022]
Abstract
Human cytomegalovirus (CMV) infection and disease remains a significant cause of morbidity and mortality for hematopoietic cell transplantation (HCT) recipients. Disruption of or weak reconstitution of virus-specific cellular immune function, such as with certain HCT approaches, poses significant risk for CMV-related complications. The incidence of and risk factors for CMV infection and the nature of CMV disease were evaluated retrospectively among 356 consecutive HCT recipients transplanted at the National Institutes of Health using all graft sources, including bone marrow, peripheral blood stem cell (PBSC), and umbilical cord blood (UCB), and a range of in vivo and ex vivo approaches for graft-versus-host disease (GVHD) prophylaxis. The cumulative incidence of CMV infection was higher for CMV-seropositive recipients at 33%, regardless of donor CMV serostatus. Patients transplanted with CMV-seropositive donors had a significantly shorter duration of antiviral therapy. Among graft sources UCB was associated with the highest cumulative incidence of CMV infection at 65% and significantly longer treatment duration at a median of 36days, whereas PBSC HCT was associated with the lowest incidence at 26% and the shortest CMV treatment duration at a median of 21days. There were significant differences in the cumulative incidence of CMV infection by T cell manipulation strategy when systemic steroids were included as a risk-modifying event. Over one-third of CMV infections occurred in the setting of systemic steroid administration. CMV disease occurred in 5% of HCT recipients, with 70% of cases in the setting of treatment for GVHD. Although factors related to serostatus, graft source, and GVHD prophylaxis were associated with varied CMV infection incidence, unplanned post-HCT corticosteroid therapy contributed greatly to the incidence of both CMV infection and disease across HCT approaches, highlighting this post-HCT intervention as a key time to potentially tailor the approach to monitoring, preemptive therapy, and even prophylaxis.
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Affiliation(s)
| | - Rachel Marchalik
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Theresa Jerussi
- Office of Patient Safety and Clinical Quality, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Dimana Dimitrova
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Veronique Nussenblatt
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Andrea Beri
- Biomedical Translational Research Information System, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Khalid Rai
- Biomedical Translational Research Information System, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Jennifer S Wilder
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland
| | - A John Barrett
- National Institute of Heart, Lung, and Blood, National Institutes of Health, Bethesda, Maryland
| | - Minoo Battiwalla
- National Institute of Heart, Lung, and Blood, National Institutes of Health, Bethesda, Maryland
| | - Richard W Childs
- National Institute of Heart, Lung, and Blood, National Institutes of Health, Bethesda, Maryland
| | - Courtney D Fitzhugh
- National Institute of Heart, Lung, and Blood, National Institutes of Health, Bethesda, Maryland
| | - Daniel H Fowler
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Terry J Fry
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ronald E Gress
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Matthew M Hsieh
- National Institute of Heart, Lung, and Blood, National Institutes of Health, Bethesda, Maryland
| | - Sawa Ito
- National Institute of Heart, Lung, and Blood, National Institutes of Health, Bethesda, Maryland
| | - Elizabeth M Kang
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Steven Z Pavletic
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Nirali N Shah
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - John F Tisdale
- National Institute of Heart, Lung, and Blood, National Institutes of Health, Bethesda, Maryland
| | - Juan Gea-Banacloche
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Jennifer A Kanakry
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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16
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Adoptive T Cell Therapy Strategies for Viral Infections in Patients Receiving Haematopoietic Stem Cell Transplantation. Cells 2019; 8:cells8010047. [PMID: 30646564 PMCID: PMC6356262 DOI: 10.3390/cells8010047] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 01/18/2023] Open
Abstract
Adverse outcomes following virus-associated disease in patients receiving allogeneic haematopoietic stem cell transplantation (HSCT) have encouraged strategies to control viral reactivation in immunosuppressed patients. However, despite timely treatment with antiviral medication, some viral infections remain refractory to treatment, which hampers outcomes after HSCT, and are responsible for a high proportion of transplant-related morbidity and mortality. Adoptive transfer of donor-derived lymphocytes aims to improve cellular immunity and to prevent or treat viral diseases after HSCT. Early reports described the feasibility of transferring nonspecific lymphocytes from donors, which led to the development of cell therapy approaches based on virus-specific T cells, allowing a targeted treatment of infections, while limiting adverse events such as graft versus host disease (GvHD). Both expansion and direct selection techniques have yielded comparable results in terms of efficacy (around 70–80%), but efficacy is difficult to predict for individual cases. Generating bespoke products for each donor–recipient pair can be expensive, and there remains the major obstacle of generating products from seronegative or poorly responsive donors. More recent studies have focused on the feasibility of collecting and infusing partially matched third-party virus-specific T cells, reporting response rates of 60–70%. Future development of this approach will involve the broadening of applicability to multiple viruses, the optimization and cost-control of manufacturing, larger multicentred efficacy trials, and finally the creation of cell banks that can provide prompt access to virus-specific cellular product. The aim of this review is to summarise present knowledge on adoptive T cell manufacturing, efficacy and potential future developments.
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17
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Atay D, Akcay A, Erbey F, Ozturk G. The impact of alternative donor types on viral infections in pediatric hematopoietic stem cell transplantation. Pediatr Transplant 2018; 22:e13109. [PMID: 29297965 PMCID: PMC7167794 DOI: 10.1111/petr.13109] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 12/27/2022]
Abstract
Viral infections remain one of the most important complications following allogeneic HSCT. Few reports compare virus infection between different donor types in pediatric patients. We retrospectively analyzed viral infections and the outcome of one hundred and seventy-one pediatric patients (median 7.38 years) who underwent allogeneic HSCT from matched related donor (MRD, n = 71), 10 of 10 HLA allele-matched unrelated donors (MUD1; n = 29), 9 of 10 HLA allele-matched unrelated donors (MUD2; n = 40), and haploidentical donors (n = 31). PCR screening for BK virus, adenovirus, Epstein-Barr virus, parvovirus B19, human herpesvirus 6, and CMV were performed routinely weekly. Infections between 0-30, 31-100, and 101 days-2 years were identified separately. BK virus and CMV reactivations were significantly low in MRD transplant patients (P = .046 and P < .0001, respectively), but incidences of all virus infections between MUD1, MUD2, and haplo-HSCT were found statistically not different. The OS was found to be affected by having one or multiple virus infection (P = .04 and P = .0008). Despite antiviral prophylaxis and treatments, post-transplant viral infections are associated with reduced overall survival. Haplo-HSCT is comparable with MUD transplantation in the setting of viral infections. A larger study group and prospective studies are needed to confirm this observation.
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Affiliation(s)
- D. Atay
- Department of Pediatric Hematology/Oncology & Bone Marrow Transplantation UnitSchool of MedicineAtakent HospitalAcıbadem UniversityIstanbulTurkey
| | - A. Akcay
- Department of Pediatric Hematology/Oncology & Bone Marrow Transplantation UnitSchool of MedicineAtakent HospitalAcıbadem UniversityIstanbulTurkey
| | - F. Erbey
- Department of Pediatric Hematology/Oncology & Bone Marrow Transplantation UnitSchool of MedicineAtakent HospitalAcıbadem UniversityIstanbulTurkey
| | - G. Ozturk
- Department of Pediatric Hematology/Oncology & Bone Marrow Transplantation UnitSchool of MedicineAtakent HospitalAcıbadem UniversityIstanbulTurkey
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