EP102 - PARVOVIRUS B19 INFECTION FOLLOWING PEDIATRIC ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION (ID 846)
Abstract
Title of Case:
PARVOVIRUS B19 INFECTION FOLLOWING PEDIATRIC ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION
Background:
Parvovirus B19 infection after pediatric allogeneic hematopoietic cell transplantation (HCT) remains a rare but under some circumstances challenging complication. There is little data in the literature regarding Parvovirus B19 infection in the context of pediatric HCT. Here we present the experience at the pediatric HCT program in Muenster.
Case Presentation Summary:
During the time period between 1999 and 2021, three out of 466 (0.6%) children and adolescents undergoing allogeneic HCT developed symptomatic community-acquired parvovirus B19 infection post-transplant. While in two patients (aplastic anemia; aplastic anemia and hemolysis), viral replication and symptoms were ultimately controlled after taper of immunosuppression and a combination of immunomodulating interventions, respectively, in the third patient, symptomatic parvovirus B19 infections now persists for more than 34 months due to ongoing immunosuppression for chronic intestinal graft-vs.-host disease. In an additional patient, parvovirus B19 replication in blood was detected during the standard evaluation prior to transplantation, which led to the postponement of the procedure until resolution of replication. In a further patient, allogeneic HCT from a matched family donor was permanently cancelled due to persistent parvoviremia of this donor at the time of the planned transplantation.
Learning Points/Discussion:
Parvovirus B19 infection is an uncommon complication after pediatric allogeneic HCT. Treatment options include the administration of intravenous immunoglobulins and taper of immunosuppressive therapy, if feasible; no antiviral treatments or cell-based adoptive immunotherapies exist. Whereas the infection itself is mostly not life-threatening, it may complicate the post-transplant course by impairing red blood cell production or by inducing auto-reactive antibodies and hemolytic anemia including hemolytic crisis. In patients with need for continuing and augmented immunosuppression for GVHD, viral replication may persist for prolonged periods of time with uncertain outcome.
