Association between Antiviral Prophylaxis and Cytomegalovirus and Epstein–Barr Virus DNAemia in Pediatric Recipients of Allogeneic Hematopoietic Stem Cell Transplant
Ndeye Soukeyna Diop,
Pascal Roland Enok Bonong,
Chantal Buteau,
Michel Duval,
Jacques Lacroix,
Louise Laporte,
Marisa Tucci,
Nancy Robitaille,
Philip C. Spinella,
Geoffrey Cuvelier,
Suzanne M Vercauteren,
Victor Lewis,
Caroline Alfieri,
Helen Trottier
Affiliations
Ndeye Soukeyna Diop
CHU Sainte-Justine Research Centre, Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC H3T 1C5, Canada
Pascal Roland Enok Bonong
CHU Sainte-Justine Research Centre, Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC H3T 1C5, Canada
Chantal Buteau
CHU Sainte-Justine Research Centre, Department of Pediatrics, Division of Infectious Diseases, Université de Montréal, Montreal, QC H3T 1C5, Canada
Michel Duval
Department of Pediatrics, Division of Hematology-Oncology, CHU Sainte-Justine, Université de Montréal, Montreal, QC H3T 1C5, Canada
Jacques Lacroix
Department of Pediatrics, Division of Pediatric Intensive Care Medicine, CHU Sainte-Justine, Université de Montréal, Montreal, QC H3T 1C5, Canada
Louise Laporte
CHU Sainte-Justine Research Centre, Montreal, QC H3T 1C5, Canada
Marisa Tucci
Department of Pediatrics, Division of Pediatric Intensive Care Medicine, CHU Sainte-Justine, Université de Montréal, Montreal, QC H3T 1C5, Canada
Nancy Robitaille
Department of Pediatrics, Division of Hematology-Oncology, CHU Sainte-Justine, Université de Montréal, and Medical Affairs, Transfusion Medicine, Héma-Québec, Ville Saint-Laurent, QC H4R 2W7, Canada
Philip C. Spinella
St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA
Geoffrey Cuvelier
Department of Pediatrics and Child Health, CancerCare Manitoba, University of Manitoba, Winnipeg, MB R3E 0V9, Canada
Suzanne M Vercauteren
Department of Pathology and Laboratory Medicine, BC Children’s Hospital, University of British Colombia, Vancouver, BC V6H 3N1, Canada
Victor Lewis
Department of Pediatrics and Department of Oncology, Alberta Children’s Hospital, University of Calgary, Calgary, AB T3B 6A8, Canada
Caroline Alfieri
CHU Sainte-Justine Research Centre, Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montréal, QC H3T 1C5, Canada
Helen Trottier
CHU Sainte-Justine Research Centre, Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC H3T 1C5, Canada
Background: Epstein–Barr virus (EBV) and cytomegalovirus (CMV) infections can have serious consequences during the period of aplasia and lymphopenia following hematopoietic stem cell transplantation (HSCT). Large pediatric cohort studies examining the effect of antiviral prophylaxis against these viruses are scarce. The present study aimed to analyse the potential effect of antiviral prophylaxis (acyclovir and famciclovir) on active post-transplant EBV and CMV infection in a pediatric cohort of allogeneic HSCT recipients. Methods: We used data from the TREASuRE cohort, consisting of 156 patients who had a first allogeneic HSCT, enrolled in four pediatric centers in Canada between July 2013 and March 2017. Follow-up was performed from the time of transplant up to 100 days post-transplant. Adjusted hazard ratio (HR) with 95% confidence intervals (CI) for the association between antiviral prophylaxis with acyclovir and/or famciclovir and EBV and CMV DNAemia was estimated using multivariate Cox regression models. Results: The post-transplant cumulative incidence of EBV and CMV DNAemia at 100 days of follow-up were, respectively, 34.5% (95% CI: 27.6–42.6) and 19.9% (95% CI: 14.5–27.1). For acyclovir, the adjusted hazard ratio (HR) for CMV and EBV DNAemia was 0.55 (95% CI: 0.24–1.26) and 1.41 (95% CI: 0.63–3.14), respectively. For famciclovir, the adjusted HR were 0.82 (95% CI: 0.30–2.29) and 0.79 (95% CI: 0.36–1.72) for CMV and EBV DNAemia, respectively. Conclusion: The antivirals famciclovir and acyclovir did not reduce the risk of post-transplant CMV and EBV DNAemia among HSCT recipients in our pediatric population.
