Evidence map›Paper›PMID 40630011›Full record

ArticleBritish journal of haematology2025

Defining a CMV viral load threshold for pre-emptive therapy in paediatric haematopoietic stem cell transplant recipients.

Amedine Duret, Oscar Charles, Ben K Margetts, John Booth, Julianne R Brown, Timothy Best, Sneha Fernandes, Persis Amrolia, Robert Chiesa, Juliana Silva and 6 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in British journal of haematology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Amedine DuretDepartment of Paediatric Infectious Diseases, Imperial College London, London, UK.ORCID https://orcid.org/0000-0002-5810-2195
Oscar CharlesInfection, Immunity, and Inflammation, Institute of Child Health, University College London, London, UK.
Ben K MargettsInfection, Immunity, and Inflammation, Institute of Child Health, University College London, London, UK.
John BoothInfection, Immunity, and Inflammation, Institute of Child Health, University College London, London, UK.
Julianne R BrownMicrobiology, Virology and Infection Prevention and Control, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Timothy BestMicrobiology, Virology and Infection Prevention and Control, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Sneha FernandesDepartment of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Persis AmroliaDepartment of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Robert ChiesaDepartment of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Juliana SilvaDepartment of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.ORCID https://orcid.org/0000-0003-1890-692X
Austen WorthDepartment of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Joseph F StandingInfection, Immunity, and Inflammation, Institute of Child Health, University College London, London, UK.
Kanchan RaoDepartment of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Elizabeth WhittakerDepartment of Academic Paediatrics, Imperial College, London, UK.
Eliza GilInfection, Immunity, and Inflammation, Institute of Child Health, University College London, London, UK.
Judith BreuerDepartment of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.

Funding

NIHR Imperial Biomedical Research CentreUCLH Biomedical Research Centre CL-2022-20-001
6 · The paper itself

Abstract

Cytomegalovirus (CMV) infection is a significant complication in paediatric haematopoietic stem cell transplant (HSCT), with substantial morbidity and mortality. While pre-emptive treatment guided by CMV viral load thresholds helps prevent end-organ disease, paediatric protocols have largely been extrapolated from adult populations without robust validation. This prospective interventional study aimed to determine an optimal viral load threshold for initiating pre-emptive CMV therapy in paediatric HSCT patients and test the impact of this threshold in real-world practice. Initially, 219 paediatric HSCT patients from 2009 to 2016 were considered, with weekly CMV quantitative polymerase chain reaction (qPCR) monitoring and treatment initiation at 2500 IU/mL. A mathematical model was developed to analyse CMV kinetics, morbidity and mortality, suggesting a threshold of 1000 IU/mL would be most suitable to prevent adverse outcomes. Subsequently, the new treatment threshold was implemented, and outcomes were then compared with a second cohort of 344 patients treated under the new guidelines from 2017 to 2021. There were significant reductions in CMV viral loads, CMV-associated end-organ disease (27/117, 23.1% vs. 4/98, 4.1%) and mortality (36/117, 30.8% vs. 19/98, 19.4%). These findings support a new evidence-based viral load threshold of 1000 IU/mL or less for pre-emptive treatment in paediatric HSCT recipients to optimise clinical outcomes.

Indexed as

Antiviral AgentsCytomegalovirusCytomegalovirus InfectionsHematopoietic Stem Cell TransplantationViral LoadAdolescentChildChild, PreschoolFemaleHumansInfantMaleProspective StudiesAntiviral AgentsBMT paedcytomegalovirusHSC transplantationvirology

Identifiers

PMID40630011
PMCPMC12436231

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.