PMID- 32017805
OWN - NLM
STAT- MEDLINE
DCOM- 20200423
LR  - 20200423
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 15
IP  - 2
DP  - 2020
TI  - Viral reactivations following hematopoietic stem cell transplantation in 
      pediatric patients - A single center 11-year analysis.
PG  - e0228451
LID - 10.1371/journal.pone.0228451 [doi]
LID - e0228451
AB  - Viral reactivation occurs frequently in the context of immunodeficiency and 
      immunosuppression after allogeneic hematopoietic stem cell transplantation 
      (allo-HSCT) and can cause severe complications. The aim of this single-center 
      retrospective analysis was to characterize viral infections in the first year 
      after HSCT, to investigate risk factors and to study the impact of viral 
      infections on transplantation outcome. This will facilitate the identification of 
      at-risk patients and the development of new preventive strategies. 107 pediatric 
      allo-HSCT from January 2005 through December 2015 were analyzed for infections 
      with Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus 6 
      (HHV-6), adenovirus (ADV), herpes simplex virus (HSV) and varicella zoster virus 
      (VZV). Viral infections were detected after 68.2% of transplantations. The 
      viruses most commonly encountered were HHV-6 (36/107) and EBV (30/107). Severe 
      viral disease was rare (7/107) and none of the patients died as result of viral 
      reactivation. Important risk factors for viral infections were higher age at 
      HSCT, donor type and occurrence of acute graft-versus-host disease (aGvHD). 
      Especially for EBV, transplant from an unrelated donor and in-vivo T-cell 
      depletion (TCD) had a significant effect on infection rates, whereas for CMV the 
      strongest effect was seen by donor and recipient serostatus with recipient 
      seropositivity most predictive for reactivation. The occurrence of severe aGvHD 
      was associated with EBV and ADV infections. For HSV, the recipient serostatus was 
      identified as prognostic factor for HSV infections, while we found higher age at 
      time of HSCT as risk factor for VZV infections. The overall survival of patients 
      with or without viral infections did not differ significantly. Interestingly, 
      when looking at the 85 patients in our cohort who had received an HSCT for a 
      malignant disease, a tendency towards lower relapse rates was seen in patients 
      affected by viral infections (HR 0.51, 95% CI 0.25 - 1.06, p = 0.072). Viral 
      reactivations are common after pediatric allo-HSCT, though severe complications 
      were rare in our collective. Determining risk factors for viral reactivations may 
      help to identify patients in need of intensified monitoring and to individualize 
      preventive strategies.
FAU - Duver, Franziska
AU  - Duver F
AD  - Department of Oncology, Hematology and Stem Cell Transplantation, University 
      Children's Hospital Wurzburg, Wurzburg, Germany.
FAU - Weissbrich, Benedikt
AU  - Weissbrich B
AD  - Institute for Virology and Immunobiology, University of Wurzburg, Wurzburg, 
      Germany.
FAU - Eyrich, Matthias
AU  - Eyrich M
AD  - Department of Oncology, Hematology and Stem Cell Transplantation, University 
      Children's Hospital Wurzburg, Wurzburg, Germany.
FAU - Wolfl, Matthias
AU  - Wolfl M
AD  - Department of Oncology, Hematology and Stem Cell Transplantation, University 
      Children's Hospital Wurzburg, Wurzburg, Germany.
FAU - Schlegel, Paul G
AU  - Schlegel PG
AD  - Department of Oncology, Hematology and Stem Cell Transplantation, University 
      Children's Hospital Wurzburg, Wurzburg, Germany.
FAU - Wiegering, Verena
AU  - Wiegering V
AD  - Department of Oncology, Hematology and Stem Cell Transplantation, University 
      Children's Hospital Wurzburg, Wurzburg, Germany.
LA  - eng
PT  - Journal Article
DEP - 20200204
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Adenoviridae/physiology
MH  - Adolescent
MH  - Adult
MH  - Child
MH  - Child, Preschool
MH  - Cytomegalovirus/physiology
MH  - Female
MH  - Graft vs Host Disease/*epidemiology/virology
MH  - Hematopoietic Stem Cell Transplantation/*adverse effects
MH  - Herpesvirus 3, Human/physiology
MH  - Herpesvirus 4, Human/physiology
MH  - Herpesvirus 6, Human/physiology
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Simplexvirus/physiology
MH  - Survival Analysis
MH  - Transplantation, Homologous/adverse effects
MH  - *Virus Activation
MH  - Virus Diseases/*epidemiology/virology
MH  - Young Adult
PMC - PMC6999888
COIS- The authors have declared that no competing interests exist.
EDAT- 2020/02/06 06:00
MHDA- 2020/04/24 06:00
PMCR- 2020/02/04
CRDT- 2020/02/05 06:00
PHST- 2019/06/22 00:00 [received]
PHST- 2020/01/15 00:00 [accepted]
PHST- 2020/02/05 06:00 [entrez]
PHST- 2020/02/06 06:00 [pubmed]
PHST- 2020/04/24 06:00 [medline]
PHST- 2020/02/04 00:00 [pmc-release]
AID - PONE-D-19-17675 [pii]
AID - 10.1371/journal.pone.0228451 [doi]
PST - epublish
SO  - PLoS One. 2020 Feb 4;15(2):e0228451. doi: 10.1371/journal.pone.0228451. 
      eCollection 2020.