Kang HM, Kim SK, Ryu IH, et al. Clinical Characteristics and Viral Load Patterns in Children With Cytomegalovirus Gastrointestinal Disease After Allogeneic Hematopoietic Stem Cell Transplantation. Bone Marrow Transplantation. 2021; (doi: 10.1038/s41409-021-01394-8).
After allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children, it is essential to actively monitor and manage cytomegalovirus (CMV) reactivation, researchers report. This is particularly important in children with delayed CD4+ and CD8+ T-cell reconstitution after allo-HSCT. The retrospective cohort study sought to characterize the clinical characteristics of children with CMV gastrointestinal (CMV GI) disease post-transplantation. Among 756 patients <19 years old who underwent allo-HSCT over an 11-year period, 55.5% (N=420) exhibited post-transplant CMV DNAemia and 2.9% were diagnosed with CMV GI diseases. For 68.2% (N=15) of the 22 patients with CMV GI disease, the condition was diagnosed <100 days of transplant; 13.6% (N=3) did not have concurrent CMV DNAemia. Based on the patterns of CMV viremia initiation and duration post-transplant, patients were divided into five groups. Patients with waxing and waning CMV viral load titers >100 days post-transplant (groups 1-3) had lower CD4+ and CD8+ T cell counts 3 months post-transplant, compared with patients who had CMV DNAemia only prior to 100 days post-transplant and those without concurrent CMV DNAemia (groups 4–5). Groups 1-3 also had increased 1-year all-cause mortality compared with groups 4-5, at 42.8% vs. 0%.