| CMV antigenemia following pediatric hematopoietic stem cell transplantation : risk factors and outcomes |
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Eun-Young Cho1, Young-Shil Park1, Dae-Hyung Lee1, Ji Kyoung Park2, Sangrhim Choi1, Sun Young Kim3, Pil-Sang Jang1, Dong-Gun Lee4, Nak-Gyun Chung1, Jong Hyun Kim1, Dae-Chul Jeong1, Bin Cho1, Jae Gyun Hur1, Jin Han Kang1, Hack-Ki Kim1 |
1Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul
2Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
3Department of Pediatrics, College of Medicine, Chungnam National University, Daejeon
4Depatment of Pediatrics, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea |
| 소아 조혈모세포 이식 후 거대세포 바이러스 항원혈증 발생 : 위험인자와 임상 경과 |
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조은영1, 박영실1, 이대형1, 박지경2, 최상림1, 김선영3, 장필상1, 이동건4, 정낙균1, 김종현1, 정대철1, 조빈1, 허재균1, 강진한1, 김학기1 |
1가톨릭대학교 의과대학 소아과학교실
2인제대학교 의과대학 부산백병원 소아과
3충남대학교 의과대학 소아과학교실
4가톨릭대학교 의과대학 내과학교실 |
Correspondence:
Bin Cho, Email: chobinkr@catholic.ac.kr
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| Abstract |
Purpose
: Cytomegalovirus(CMV) infection still remains as a major cause of morbidity and mortality after stem cell transplantation. In this study, we analyzed the results of antigenemia-guided pre- emptive therapy among children with allogeneic hematopoietic stem cell transplantation to determine the incidence and risk factors associated with CMV antigenemia, and evaluated the efficacy of the CMV antigenemia based preemptive therapy.
Methods
: We enrolled 213 pediatric patients following allogeneic hematopoietic stem cell transplantation(HSCT), at the Catholic HSCT center between October 1998 and December 2003. Pre-emptive ganciclovir was started when more than 5 CMV Ag-positive cells were detected in matched sibling HSCT, and when any Ag-positive cells were seen in unrelated allogenic HSCT.
Results
: CMV antigenemia was observed in 88(41.3 percent) of 213 patients on median day 28(day 11-99). In univariated analysis, use of unrelated donors(other than siblings), age of recipient(more than 5 years at transplant) at transplantation, the presence of recipient CMV-IgG before transplantation, TBI-based conditioning regimen and the presence of acute GvHD(grade ≥II) were the risk factors for positive CMV antigenemia. In multivariate analysis, unrelated bone marrow transplantation, positive recipient CMV serology and acute GvHD(grade ≥II) were the independent risk factors for positive CMV antigenemia.
Conclusion
: Risk factors of CMV infection in children were CMV serostatus of the recipient, the source of stem cells, and acute graft-versus-host disease. The pre-emptive therapy based on CMV antigenemia was effective in the prevention of CMV disease. |
| Key Words:
Cytomegalovirus , CMV antigenemia , Pre-emptive therapy , Hematopoietic stem cell transplantation |
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