Objective. The aim was to characterize risk factors for EBV and CMV viremia in allo-HSCT children in Hadassah Medical Center.
Methods. A single center retrospective (2011-2015) study. Demographic, underlying disease and HSCT-related data was compared in patients with or without CMV or EBV viremia.
Results. 111 children underwent 117 allo-HSCT, 70 (60%) due to non-malignant diseases. CMV (≥100 copies/ml) or EBV (≥1000 copies/ml) viremia rates were 62 (53%) and 32 (27%), respectively.
In the univariate analysis, CMV viremia before HSCT (P = 0.002) and CMV-seropositive recipient (R+) (p<0.001) predisposed to CMV viremia. In the multivariate analysis, R+ predisposed to CMV viremia (OR=15.253). Median time to episode was 31 days post-HSCT in malignancy and 12 days in non-malignancy patients (p=0.02). More malignancy patients developed CMV viremia during steroid treatment and GVHD. More non-malignancy patients developed CMV episode under cyclosporine treatment and gastro-intestinal GVHD.
In the univariate analysis, peripheral blood source (PBS, P<0.001) and mismatched or matched unrelated donor (P=0.035) predisposed to EBV viremia. In the multivariate analysis, PBS predisposed to EBV viremia (OR=6.460). Four patients were suspected having post-transplant lymphoproliferative disease.
Twenty-five children (21.5%) died after HSCT, none of these deaths were attributed to CMV or EBV.
Conclusions. In our allo-HSCT children, high proportion having non-malignant diseases, we found increased risk of CMV viremia in patients with pre-transplant viremia, and of EBV viremia in patients following PBS HSCT, factors underreported in the literature. Further research identifying unique underlying disease-related risk factors will enable personalized treatment approach to HSCT children.
