Pediatric blood & cancer · 2026
Biphasic Clinical Course of Pediatric Cytomegalovirus-Associated Immune Thrombocytopenia: Early Poor Treatment Response but Favorable Long-Term Outcomes.
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Gilad Oded, Atia Ohad, Tanous Osama, Brik Simon Dafna, Dvori Michal, Cohen Miriam, Goldberg Tracie A, Bilavsky Efraim, Yacobovich Joanne, Steinberg-Shemer Orna
Аннотация
BACKGROUND: Cytomegalovirus (CMV) is a recognized trigger of immune thrombocytopenia (ITP); however, its incidence and impact on disease course in children remain controversial. Therefore, we aimed to characterize the clinical course of pediatric patients with CMV-associated ITP.
PROCEDURES: We conducted a single-center retrospective cohort study of children with ITP, analyzing clinical and laboratory characteristics, treatment, and outcomes in CMV-positive (CMVpos) and CMV-negative (CMVneg) patients. Univariable and multivariable logistic regression analyses were performed to evaluate the association between CMV status and remission.
RESULTS: Of 444 children with ITP, 25 (5.6%) were CMVpos. At diagnosis, CMVpos patients had significantly lower median platelet counts (5 × 103 (interquartile range [IQR] (3-9)) vs. 11 × 103 (IQR 5-24)/µL, p = 0.01), hemoglobin levels, absolute neutrophil counts, and higher rates of transaminase elevation; nonetheless, bleeding severity was similar. CMVpos patients more frequently received multiple treatment courses at diagnosis (52.2% vs. 17.8%, p < 0.001). However, during follow-up at 3-12 months from diagnosis, only 8% of CMVpos patients received treatment as compared with 30.6% of CMVneg patients (p = 0.01), whereas at 12 months remission rates were significantly higher among CMVpos patients (84% vs. 59.6%, p = 0.018). Only one CMVpos patient received antiviral therapy. In univariable and multivariable logistic regression analyses, CMV positivity was independently associated with 12-month ITP remission (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.34-12.54 and OR 3.78, 95% CI 1.0004-20.16, respectively).
CONCLUSIONS: CMV-associated ITP is uncommon and follows a characteristic clinical course, marked by early poor treatment response followed by favorable long-term outcomes. Identification of CMV in pediatric ITP patients provides important prognostic information regarding disease trajectory.
PROCEDURES: We conducted a single-center retrospective cohort study of children with ITP, analyzing clinical and laboratory characteristics, treatment, and outcomes in CMV-positive (CMVpos) and CMV-negative (CMVneg) patients. Univariable and multivariable logistic regression analyses were performed to evaluate the association between CMV status and remission.
RESULTS: Of 444 children with ITP, 25 (5.6%) were CMVpos. At diagnosis, CMVpos patients had significantly lower median platelet counts (5 × 103 (interquartile range [IQR] (3-9)) vs. 11 × 103 (IQR 5-24)/µL, p = 0.01), hemoglobin levels, absolute neutrophil counts, and higher rates of transaminase elevation; nonetheless, bleeding severity was similar. CMVpos patients more frequently received multiple treatment courses at diagnosis (52.2% vs. 17.8%, p < 0.001). However, during follow-up at 3-12 months from diagnosis, only 8% of CMVpos patients received treatment as compared with 30.6% of CMVneg patients (p = 0.01), whereas at 12 months remission rates were significantly higher among CMVpos patients (84% vs. 59.6%, p = 0.018). Only one CMVpos patient received antiviral therapy. In univariable and multivariable logistic regression analyses, CMV positivity was independently associated with 12-month ITP remission (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.34-12.54 and OR 3.78, 95% CI 1.0004-20.16, respectively).
CONCLUSIONS: CMV-associated ITP is uncommon and follows a characteristic clinical course, marked by early poor treatment response followed by favorable long-term outcomes. Identification of CMV in pediatric ITP patients provides important prognostic information regarding disease trajectory.