ArticleClinical transplantation and research2026
Cytomegalovirus infection post-hematopoietic stem cell transplantation: a real-world perspective on risk factors and clinical practice.
Article in Clinical transplantation and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Cytomegalovirus (CMV) infection remains a major cause of morbidity, mortality, and increased healthcare burden in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Its clinical manifestations range from asymptomatic CMV replication to end-organ diseases such as pneumonia, gastroenteritis, and retinitis, all of which are associated with a higher rate of nonrelapse mortality. Methods: We reviewed case records of children who underwent allo-HSCT at our center between April 2013 and October 2024. CMV monitoring was performed weekly until at least day +100 post-HSCT using a quantitative polymerase chain reaction assay. All patients received acyclovir prophylaxis. Pre-emptive intravenous ganciclovir therapy was initiated when CMV-DNA levels exceeded 500 IU/mL. Results: A total of 150 consecutive patients (58% male) were included. The median age at HSCT was 6.3 years (interquartile range [IQR], 3.4-11.3 years). Indications for HSCT were hematologic malignancy (n=81, 54.0%), inborn errors of immunity and bone marrow failure (n=46, 30.7%), and hemoglobinopathy (n=23, 15.3%). Donor and recipient CMV seropositivity rates were 86.7% and 94.0%, respectively. CMV infection occurred in 43.4% of patients, with a median onset of 30 days post-HSCT (IQR, 21-47 days). There were five (3.3%) cases of CMV disease, resulting in one (0.7%) CMV-related death. Human leukocyte antigen (HLA)-haploidentical donor status (odds ratio [OR], 5.00; 95% confidence interval [CI], 2.43-10.29; P<0.001) and the use of serotherapy in the conditioning regimen (OR, 2.87; 95% CI, 1.47-5.60; P=0.002) were significantly associated with an increased risk of CMV infection. Conclusions: CMV infection was a common occurrence, particularly among patients with HLA-haploidentical donors. Preventive strategies such as weekly surveillance and pre-emptive ganciclovir therapy proved effective in preventing overt CMV disease.
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