Differential risk of viral infections in children undergoing complex anticancer therapy or hematopoietic stem cell transplantation
Abstract
Background: Infections constitute a major problem for patients during oncological treatment or undergoing
hematopoietic stem cell transplantation (HCT).
Objective: The aim of the study was to analyze the epidemiology of viral infections in children during anticancer
therapy (PHO, pediatric haematology and oncology) or after HCT over a period of consecutive
6 years in a single-centre study.
Patients and methods: During this period, a total number of 182 HCTs were performed, and 306 children
were newly diagnosed for malignancy. Incidence, hazard risk and outcome of infections were analyzed.
Results: The cumulative incidence of viral infections was 61.7% in allo-HCT, 8.5% in PHO, and 4.1% in
auto-HCT patients. The overall risk of viral infection in HCT patients was 17.3-fold higher (p < 0.0001)
than in PHO patients. The risk was 30-fold higher for CMV and 63-fold higher for EBV, while the risk was
comparable for influenza and adenovirus infection. Infections with polyoma BKV occurred only in HCT
patients after allo-HCT. Factors contributing to increased risk of viral infections in allo-HCT patients both in
uni- and multivariate analysis were: male sex, diagnosis of acute leukemia, alternative donor, CMV positive
serostatus in recipient and/or donor, acute and chronic GVHD. All patients except two allo-HCT children
survived viral infections. The cause of death were influenza and EBV-PTLD.
Conclusions: The risk of viral infections in allo-HCT patients is much higher than in auto-HSCT and PHO
patients, while the outcome of infections was better in the PHO and auto-HCT setting.
Keywords: viral infectionsmalignant diseasespediatric haematology and oncologyhematopoietic stem cell transplantationchildren
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