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

Cho, Eun-Young (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Park, Young-Shil (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Lee, Dae-Hyung (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Park, Ji Kyoung (Depatment of Pediatrics, Pusan Paik Hospital, College of Medicine, Inje University)
Choi, Sangrhim (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Kim, Sun Young (Department of Pediatrics, College of Medicine, Chungnam National University)
Jang, Pil-Sang (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Lee, Dong-Gun (Department of Internal Medicine, College of Medicine, The Catholic University of Korea)
Chung, Nak-Gyun (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Kim, Jong-Hyun (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Jeong, Dae-Chul (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Cho, Bin (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Hur, Jae Gyun (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Kang, Jin Han (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Kim, Hack Ki (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Publication Information
Clinical and Experimental Pediatrics / v.49, no.2, 2006 , pp. 173-180 More about this Journal
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 preemptive 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 ${\geq}II$) were the risk factors for positive CMV antigenemia. In multivariate analysis, unrelated bone marrow transplantation, positive recipient CMV serology and acute GvHD(grade ${\geq}II$) 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;
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