439. Betaherpesviruses in children with cancer
Session: Poster Abstract Session: Pediatric Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Goldfarb. IDSA 2013.pdf (1.4 MB)
  • Background: Human herpesvirus 6 (HHV-6) is a ubiquitous virus, most children acquire by primary infection by age 2 years. HHV-6 has been associated with serious illness after immune suppression associated with organ transplantation, and is prospectively screened in some institutions after organ transplantation. HHV-6 and the other human betaherpesviruses (cytomegalovirus and HHV-7) have not been well studied in children undergoing cancer chemotherapy. Because these viruses can become latent, finding one during acute illness does not prove a pathogenic role. Our objective was to longitudinally evaluate for the presence of the human betaherpesviruses and EBV from the onset of chemotherapy through the first 2 years after diagnosis of a malignancy in children treated at the CCCH. Methods: We enrolled 77 children with newly diagnosed malignancy requiring chemotherapy and followed prospectively for 2 years. Blood specimens were collected every 2 weeks for the first 6 months, every month for the next 6 months, and then every 3 months. Specimens were also collected during acute illness. DNA was extracted for PCR of  HHV-6, HHV-7, CMV and EBV. Samples from each child were run together after all were collected. Analysis was complete-case based and tests were two tailed and performed with SAS 9.2 software. Results:   Seventy-three children had evaluable data: 39M/34F with a mean age of 10.1 years (range 6m to 21 y) at enrollment. Deaths: 14; lost to follow up: 3(transferred care). Diagnoses included leukemia/lymphoma (29), histocytosis (3), brain tumor (4), and other (38).  There were 159 acute visits in 48 of the children and 907 routine visits in the first year. Of the 48 with acute visits, 31 had +PCR for HHV-6. HHV-6 PCR was + in 10% of both acute and routine visits.  HHV-6 was not more likly positive during acute than during a routine visit. HHV-6 viremia was significantly associated with younger age, chemotherapy, and marginally with steroids, but not with acute visits. It was not associated with CMV or EBV reactivation or infection. Conclusion: HHV-6 PCR positivity occurred in a significant proportion of pediatric cancer patients over the course of the first year (51%) of treatment. However it occurred with similar frequency during acute and routine visits. If HHV-6 is not assessed longitudinally clinical events may be misattributed to the virus.
    Johanna Goldfarb, MD1, Nirica Borges, M.D.2, L Kate Gowans, M.D.3, Lara Danziger-Isakov, MD4,5, Sarah Worley, MS6, Liang Li, PhD7, Belinda Yen-Lieberman, Ph.D.8, Donna Lach, RN9, Debbie Kohn8, Stephanie Yee-Guardino, DO10,11 and Philip E. Pellett, PhD12, (1)Center for Pediatric Infectious Diseases, Cleveland Clinic Children's Hospital, CLEVELAND, OH, (2)Pediatric Infectious Diseases, Cleveland Clinic Children's Hospital, Pittsburgh, PA, (3)Pediatric Hematology and Oncology, Cleveland Clinic Children's Hospital, Cleveland, OH, (4)Infectious Disease, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (5)Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (6)Biostatistics, Cleveland Clinic Children's Hospital, Cleveland, OH, (7)Quantitative Health Sceiences, Cleveland Clinic, Cleveland, OH, (8)Clinical Pathology, Cleveland Clinic, Cleveland, OH, (9)Pediatric Infectious Diseases, Cleveland Clinic Children's Hospital, Cleveland, OH, (10)Cleveland Clinic, Cleveland, OH, (11)The Children's Hospital, Cleveland Clinic, Cleveland, OH, (12)Immunology and Microbiology, Wayne State University, Detroit, MI

    Disclosures:

    J. Goldfarb, None

    N. Borges, None

    L. K. Gowans, None

    L. Danziger-Isakov, None

    S. Worley, None

    L. Li, None

    B. Yen-Lieberman, None

    D. Lach, None

    D. Kohn, None

    S. Yee-Guardino, None

    P. E. Pellett, None

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