Cytomegalovirus,adenovirus, and polyomavirus co‐infection among pediatric recipients of allogeneic stem cell transplantation: Characteristics and outcome

Watcharananan SP, Kiertiburanakul S, Piyatuctsanawong W, Anurathapan U, Sungkanuparph S, Pakakasama S, Chantratita W, Hongeng S. Cytomegalovirus, adenovirus, and polyomavirus co‐infection among pediatric recipients of allogeneic stem cell transplantation: Characteristics and outcome.
Pediatr Transplantation 2010: 14:675–681. © 2010 John Wiley & Sons A/S. Abstract: ADV and PMV infection have increasingly been documented as significant complications following allo‐HSCT. Despite increasing recognition, characteristics and outcome of CMV, ADV, and PMV viral co‐infection remain obscured. In this study, a retrospective quantitative PCR analysis of ADV, PMV (BKV and JCV) was performed from pediatric patients’ stored blood samples previously tested for CMV viremia after allo‐HSCT. Clinical and virological characteristics and outcome among patients with and without viral co‐infection were analyzed and compared. From 2001 to 2006, 219 blood samples from 69 patients were studied. Viral DNA was present in 119 samples (52.9%).The proportion of viremia was highest for BKV (30.6%), followed by CMV (20.9%), ADV (9.1%), and JCV (0.5%). Viral co‐infection occurred in 17 patients (24.6%), with CMV/BKV as the most common type (11.6%), followed by CMV/ADV (4.3%) and ADV/BKV (2.9%). From multivariate analysis, factors associated with viral co‐infection were acute GVHD (OR 4.57; 95% CI 1.9–10.96, p = 0.001), level of blood CMV viral load (OR 1.53; 95% CI 1.24–1.89, p < 0.001), and level of blood ADV viral load (OR 1.56; 95% CI 1.05–2.32, p = 0.027). Higher probability of developing viral disease was strongly associated with more types of virus detected in blood (p < 0.001). Significant difference in the causes of death was observed among patients with and without viral co‐infection (p = 0.014). Infection (87.5%) was the major cause of death of patients with viral co‐infection, whereas relapse of hematologic disease (70%) was the major cause of death of patients with mono‐viral infection. Viral co‐infection is a common and significant infectious complication in pediatric recipients of allo‐HSCT. Blood monitoring of CMV, ADV, and BKV is suggested among pediatric patients who develop GvHD or who have rising of CMV or ADV viremia following allo‐HSCT.