Transfusion-Related Epstein-Barr Virus (EBV) Infection Among Stem Cell Transplant Recipients: a Retrospective Cohort Study In Children
Bibliographic record
Abstract
Abstract Abstract 3340 Background: In many countries, numerous steps are taken to minimize the risk of infection from transfused blood or blood products. While the risk of transfusion-related infections such as HIV and HCV has become exceedingly rare, the risk of transfusion transmitted infectious diseases for which testing is not currently performed continues to be a major concern. Any infectious agent with a blood phase has the potential to be transmitted by transfusion. Among these untested microbial agents is Epstein-Barr virus (EBV/HHV-4), which, in the transplant setting, may cause lymphoproliferative disease, a potentially fatal cancer. Pediatric patients who are EBV-seronegative at the time of transplant are at high risk for developing this disease upon EBV infection during the early post-transplant period. Objective: Given that blood products are routinely administered to stem cell (includes bone marrow and cord-blood) transplant patients, this study was initiated to examine the incidence of transfusion-related post-transplant EBV infection in children receiving a stem cell graft. Methods: Patient charts were reviewed for: 1) the presence or absence of EBV antibodies (EBNA, VCA, EA) in pre-transplant sera from recipients and donors, 2) the incidence of post-transplant EBV infection (through PCR testing of recipients' blood), and 3) the characteristics of the children (age, sex, etc.) and their transfusion history. Results: Ste-Justine Hospital records revealed a total of 488 stem cell grafts performed on 429 patients between 1993 and 2009. Among these patients, 42% (179) were girls and 58% (250) were boys. The mean and median age at transplantation was 9.1 years (SD=6.1) and 8.8 years (IQR:3.6-14.5), respectively. Transplantations were subdivided into 3 categories: autologous (32%), allogeneic-cord blood (27%), allogeneic-other (41%). The seroprevalence of EBV was 80% and 66% in recipients and donors, respectively. Our data indicate that 25% of naïve recipients (no antibodies before transplantation) developed EBV viremia (positive PCR in blood) within a median time of 73 days following transplantation. Transmission of EBV may have occurred through virus contained either in the transplanted bone marrow or in the transfused blood products. Interestingly, EBV infection occurred in 16% of naïve recipients following cord-blood transplantation (known to be EBV negative). Barring natural infection, which is possible but unlikely, this strongly points to blood products as the vehicle for transmission. Conclusion: In view of the association between EBV and post-transplant lymphoproliferative disease, seen most often in patients who undergo primary EBV infection soon after transplant, the transmission of EBV via blood or blood products merits special consideration in further studies. Funding: FRSQ Grant #13904. Disclosures: No relevant conflicts of interest to declare.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".