Understanding Risk Factors for Cytomegalovirus Infection in Pediatric Hematopoietic Stem Cell Transplantation: Insights From a 10-Year Study Comparing Conditioning Regimens

Hematopoietic stem cell transplantation is a curative therapy for pediatric patients with malignancies and blood or immune system disorders. However, recipients are at risk of opportunistic infections, including cytomegalovirus infection, due to immunosuppression from conditioning regimens. This retrospective study analyzed 439 pediatric hematopoietic stem cell transplantation patients to identify risk factors for cytomegalovirus infection and assess the impact of conditioning regimens. Significant factors included graft source, graft versus host disease, and pre-transplant clinically significant cytomegalovirus infection. Myeloablative conditioning regimens and the use of anti-thymocyte globulin increased the risk of clinically significant cytomegalovirus infection. Additionally, the risk of cytomegalovirus infection in patients was found to be statistically significant in the myeloablative subgroup analyses who received anti-thymocyte globulin alone and those who received both anti-thymocyte globulin and total body irradiation. In our study, total body irradiation did not significantly affect the risk of clinically significant cytomegalovirus infection. This study covers a 10-year period and a large pediatric patient population from a single center. Our findings highlight the importance of understanding risk factors for clinically significant cytomegalovirus infection to guide preventive strategies in pediatric HSCT recipients.