Monitoring and Management of Cytomegalovirus Reactivations After Allogeneic Hematopoietic Stem Cell Transplantation in Children: Experience from a Single Pediatric Center
Background: CMV reactivation represents a frequent complication after HSCT. The aim of this study was to describe the incidence of CMV reactivation in a pediatric HSCT cohort and analyze the potential impact of recipient/donor-related or transplant-related factors on this complication. Furthermore,...
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2024-11-01
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| author | Giulia Ferrando Francesca Bagnasco Stefano Giardino Filomena Pierri Sara Pestarino Eddi Di Marco Maria Santaniello Elio Castagnola Maura Faraci |
| author_facet | Giulia Ferrando Francesca Bagnasco Stefano Giardino Filomena Pierri Sara Pestarino Eddi Di Marco Maria Santaniello Elio Castagnola Maura Faraci |
| author_sort | Giulia Ferrando |
| collection | DOAJ |
| description | Background: CMV reactivation represents a frequent complication after HSCT. The aim of this study was to describe the incidence of CMV reactivation in a pediatric HSCT cohort and analyze the potential impact of recipient/donor-related or transplant-related factors on this complication. Furthermore, we analyzed the management of CMV reactivation in order to purpose criteria for pre-emptive therapy. Methods: Allogeneic HSCTs, performed at IRCCS Istituto Gaslini between 2012 and 2022, were included in this analysis. CMV–DNAemia was regularly monitored. Risk stratification was based on donor/recipient serological status and additional potential risk factors were considered: haploidentical transplant; any HSCT subsequent to the first; acute and chronic GvHD; steroids; and other immunosuppressive therapies. We described also the approach for pre-emptive therapy during the period 2012–2019. Results: A total of 214 allogeneic HSCTs were performed in 189 patients. In total, 100 (46.7%) HSCTs were complicated by at least one reactivation. CMV reactivation was significantly associated with high serological risk and steroid treatment. Pre-emptive therapy was administered in 59/69 (85.5%) HSCTs during 2012–2019. In the presence of predefined risk conditions, therapy was started at a median viremia of 2050 copies/mL. No difference was observed in OS between patients with CMV reactivation versus patients who did not present this complication. Conclusions: These results suggest the potential effectiveness of the approach used in providing pre-emptive therapy based on viral load monitoring and individualized risk factors. |
| format | Article |
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| institution | DOAJ |
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| language | English |
| publishDate | 2024-11-01 |
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| spelling | doaj-art-ac8a5eaf2a864e028c6aa77647a8d6512025-08-20T02:49:56ZengMDPI AGDiagnostics2075-44182024-11-011421246110.3390/diagnostics14212461Monitoring and Management of Cytomegalovirus Reactivations After Allogeneic Hematopoietic Stem Cell Transplantation in Children: Experience from a Single Pediatric CenterGiulia Ferrando0Francesca Bagnasco1Stefano Giardino2Filomena Pierri3Sara Pestarino4Eddi Di Marco5Maria Santaniello6Elio Castagnola7Maura Faraci8Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto G. Gaslini, 16147 Genova, ItalyEpidemiology and Biostatistics, Scientific Directorate, IRCCS Istituto G. Gaslini, 16147 Genova, ItalyHematopoietic Stem Cell Transplant Unit, Department of Hemato-Oncology, IRCCS Istituto G. Gaslini, 16147 Genova, ItalyHematopoietic Stem Cell Transplant Unit, Department of Hemato-Oncology, IRCCS Istituto G. Gaslini, 16147 Genova, ItalyHematopoietic Stem Cell Transplant Unit, Department of Hemato-Oncology, IRCCS Istituto G. Gaslini, 16147 Genova, ItalyMolecular Medicine Laboratory, IRCCS Istituto G. Gaslini, 16147 Genova, ItalyInfectious Diseases Unit, Department of Pediatrics, IRCCS Istituto G. Gaslini, 16147 Genova, ItalyInfectious Diseases Unit, Department of Pediatrics, IRCCS Istituto G. Gaslini, 16147 Genova, ItalyHematopoietic Stem Cell Transplant Unit, Department of Hemato-Oncology, IRCCS Istituto G. Gaslini, 16147 Genova, ItalyBackground: CMV reactivation represents a frequent complication after HSCT. The aim of this study was to describe the incidence of CMV reactivation in a pediatric HSCT cohort and analyze the potential impact of recipient/donor-related or transplant-related factors on this complication. Furthermore, we analyzed the management of CMV reactivation in order to purpose criteria for pre-emptive therapy. Methods: Allogeneic HSCTs, performed at IRCCS Istituto Gaslini between 2012 and 2022, were included in this analysis. CMV–DNAemia was regularly monitored. Risk stratification was based on donor/recipient serological status and additional potential risk factors were considered: haploidentical transplant; any HSCT subsequent to the first; acute and chronic GvHD; steroids; and other immunosuppressive therapies. We described also the approach for pre-emptive therapy during the period 2012–2019. Results: A total of 214 allogeneic HSCTs were performed in 189 patients. In total, 100 (46.7%) HSCTs were complicated by at least one reactivation. CMV reactivation was significantly associated with high serological risk and steroid treatment. Pre-emptive therapy was administered in 59/69 (85.5%) HSCTs during 2012–2019. In the presence of predefined risk conditions, therapy was started at a median viremia of 2050 copies/mL. No difference was observed in OS between patients with CMV reactivation versus patients who did not present this complication. Conclusions: These results suggest the potential effectiveness of the approach used in providing pre-emptive therapy based on viral load monitoring and individualized risk factors.https://www.mdpi.com/2075-4418/14/21/2461hematopoietic stem cell transplantationviral infectioncytomegaloviruspre-emptive therapy |
| spellingShingle | Giulia Ferrando Francesca Bagnasco Stefano Giardino Filomena Pierri Sara Pestarino Eddi Di Marco Maria Santaniello Elio Castagnola Maura Faraci Monitoring and Management of Cytomegalovirus Reactivations After Allogeneic Hematopoietic Stem Cell Transplantation in Children: Experience from a Single Pediatric Center Diagnostics hematopoietic stem cell transplantation viral infection cytomegalovirus pre-emptive therapy |
| title | Monitoring and Management of Cytomegalovirus Reactivations After Allogeneic Hematopoietic Stem Cell Transplantation in Children: Experience from a Single Pediatric Center |
| title_full | Monitoring and Management of Cytomegalovirus Reactivations After Allogeneic Hematopoietic Stem Cell Transplantation in Children: Experience from a Single Pediatric Center |
| title_fullStr | Monitoring and Management of Cytomegalovirus Reactivations After Allogeneic Hematopoietic Stem Cell Transplantation in Children: Experience from a Single Pediatric Center |
| title_full_unstemmed | Monitoring and Management of Cytomegalovirus Reactivations After Allogeneic Hematopoietic Stem Cell Transplantation in Children: Experience from a Single Pediatric Center |
| title_short | Monitoring and Management of Cytomegalovirus Reactivations After Allogeneic Hematopoietic Stem Cell Transplantation in Children: Experience from a Single Pediatric Center |
| title_sort | monitoring and management of cytomegalovirus reactivations after allogeneic hematopoietic stem cell transplantation in children experience from a single pediatric center |
| topic | hematopoietic stem cell transplantation viral infection cytomegalovirus pre-emptive therapy |
| url | https://www.mdpi.com/2075-4418/14/21/2461 |
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