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  • Author
    Calvin Lau
  • Co-author

    Calvin E. Lau, David J. DiTullio, LaVette Bowles, Theodore B. Moore, Satiro De Oliveira

  • Title

    Viral infection rates and associated serious complications in pediatric umbilical cord blood transplant patients over the last decade

  • Abstract

    Background: Umbilical cord blood (UCB) transplantation has been demonstrated to be associated with higher risk of viral infections, but few studies have examined the rates of viral infections and morbidity in the pediatric population.  

    Patients and methods: Retrospective assessment of all pediatric patients who received an UCB transplant at UCLA from January 2007 to December 2017. Pre-transplant screening included serologies for CMV, HSV, EBV and hepatitis viruses. Prophylaxis was administered to patients seropositive for CMV and HSV, consisting of ganciclovir 6 mg/kg over days -7 to -2 and acyclovir 10-20 mg/kg/dose BID or TID from day 0 to +100, respectively.      

    Results: Sixty-two patients received 65 UCB transplants, 47 for malignancies and 18 for genetic disorders; the incidence of viral infections at thirty days and at one year after transplantation were 27.7% and 43.0%, respectively. Some patients were diagnosed with more than one viral infection in the first year after transplant (13.8%), and the adjusted incidence of viral infections was highest in the 16-21 age group (87.5%). Among patients who received prophylaxis, the incidences of CMV viremia and HSV infections were 45.5%% and 10.7%, similar to the literature. Of 33 CMV seropositive patients, viral reactivation progressing to CMV disease occurred in 30.3% of patients. HHV6 viral encephalitis was diagnosed in 5 patients, and 1 patient developed adenovirus encephalitis. Graft failure occurred in 12.3% of patients. Of 47 transplants for malignant disease, 14.9% patients died of relapse. Of 29 reported deaths, GvHD was the cause of death in 9.2% of these cases. Infections in the absence of relapsed disease or GvHD contributed to 41.3% of deaths. Respiratory viral infections contributed to the death of 3 patients.  

    Conclusion: Pre-transplant serological screening and viral prophylaxis were effective in preventing infections in patients with UCB transplants. Strategies for prevention and therapy of viral infections will improve transplantation outcomes.  

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