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Infect Dis (Lond). 2019 Oct;51(10):772-778. doi: 10.1080/23744235.2019.1650198. Epub 2019 Aug 5.

Viral infections and immune reconstitution interaction after pediatric allogenic hematopoietic stem cell transplantation.

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Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, New Children's Hospital, Helsinki University Hospital , Helsinki , Finland.
Faculty of Medicine, University of Helsinki , Helsinki , Finland.
New Children's Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital , Helsinki , Finland.
Inflammation Center, Helsinki University Hospital , Helsinki , Finland.
Department of Virology and Immunology, Helsinki University Hospital , Helsinki , Finland.


Background: Viral infections are a major cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Although immune suppression plays a central role, the literature shows conflicting results on interplay between post-transplant immune reconstitution (IR) and viral infections. Methods: We prospectively studied viral infections and IR in 30 pediatric patients undergoing allogenic HSCT, with a follow-up time of 24 months. In total, 1337 blood (CMV, EBV, HHV-6, ADV and BKV) and urine (BKV and JCV) virus samples were analyzed. IR including B-cells (CD19+), T cells (CD3+, CD4+, CD8+) and NK-cells were measured. Clinical outcomes included overall survival (OS), non-relapse mortality (NRM), graft-versus-host disease (GVHD) and occurrence of blood culture positive bacterial infections. Results: We found BKV reactivation to be most frequent, 47% of the children had viremia and 77% viruria. The frequencies of CMV, HHV-6 and adeno viremia were 37%, 37% and 6%, respectively. Viremias beyond 3 months post-HSCT were uncommon. Factors such as GVHD, use of steroids, EBV and CMV infections and pre-transplant irradiation affected IR. No specific viral infection or IR related factor was associated to OS or NRM. Conclusions: Viral infections and IR interact in a bi-directional manner. Accordingly, close follow-up of both IR and viral loads is warranted.


HSCT; Virus; immune reconstitution; pediatric; transplantation

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