Viral infections in children undergoing hematopoietic stem cell transplant

Background Although viral infection is a major clinical problem for hematop oietic stem cell transplant recipients, there are few large series reportin g on these infections in the pediatric population. We performed a retrospec tive analysis of the impact of viral infections in this patient population in our center, managed by a uniform antiviral prophylaxis protocol. Method We reviewed the medical records of consecutive children and adolesce nts who received hematopoietic stem cell transplantation at the Division of Pediatrics, The University of Texas M. D. Anderson Cancer Center in Housto n, TX, from July, 1992 to August, 1996. Results. During the study period there were 70 episodes of viral infections in 96 transplants. The viruses most commonly encountered were cytomegalovi rus (24), varicella-zoster (21) and herpes simplex (10). Fifty of these epi sodes resulted in clinically apparent diseases, affecting 39 patients. The Kaplan-Meier estimated probability for the development of viral diseases wa s 62%. Ten percent of these patients died as a direct result of the infecti ous process, all within 4 months of transplant. Significant factors for dev elopment of viral disease were the development of acute graft-vs. -host dis ease and the duration of preengraftment neutropenia. Conclusions. Viruses are common pathogens after hematopoietic stem cell tra nsplantation in the pediatric population. Despite routine antiviral prophyl axis the morbidity and mortality of viral infections remain high. Enhanceme nt of immune recovery after hematopoietic stem cell transplantation togethe r with the development of new classes of antiviral agents may impact the in cidence and prognosis of viral infections in this setting.