All issues > Volume 49(2); 2006

Original Article

Korean J Pediatr. 2006;49(2):173-180. Published online February 15, 2006.

CMV antigenemia following pediatric hematopoietic stem cell transplantation : risk factors and outcomes

Eun-Young EY Cho¹, Young-Shil YS Park¹, Dae-Hyung DH Lee¹, Ji Kyoung JK Park², Sangrhim SR Choi¹, Sun Young SY Kim³, Pil-Sang PS Jang¹, Dong-Gun DG Lee⁴, Nak-Gyun NG Chung¹, Jong Hyun JH Kim¹, Dae-Chul DC Jeong¹, Bin B Cho¹, Jae Gyun JG Hur¹, Jin Han JH Kang¹, Hack-Ki HK 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

Correspondence Bin B Cho ,Email: chobinkr@catholic.ac.kr

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.

Keywords :Cytomegalovirus , CMV antigenemia , Pre-emptive therapy , Hematopoietic stem cell transplantation