{
  "abstract": "Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) reactivations are major complications after hematopoietic stem cell transplantation (HCT), but co-infection epidemiology and outcomes in combined adult-pediatric cohorts remain poorly defined. This retrospective single-center study analyzed 941 consecutive HCT recipients (2015-2023). CMV and EBV were quantified by whole-blood qPCR (positivity ≥153 and ≥433 copies/mL, respectively). CMV testing was weekly until day +100 post-HSCT; EBV testing followed clinical indication at the treating physician's discretion. IgG serostatus is not routinely tested at KHCC for post-transplant monitoring. Acknowledging some missing values, we evaluated the incidence, risk factors, and survival impact of CMV/EBV co-infection using chi-square tests, Kaplan-Meier analysis, and multivariable logistic and Cox proportional-hazards regression. Among 941 recipients (56.5% adult, 43.5% pediatric), adults received 89.1% of CMV tests (838/941) and 76.6% of CMV infections (105/137), whereas pediatric patients accounted for 59.8% of EBV infections (76/127); EBV testing covered 65.5% (616/941). Co-infection incidence was 7.6% (70/916). Co-infection was significantly associated with allogeneic transplant (p=0.004), haploidentical donor (p=0.010), reduced-intensity conditioning (p=0.017), and acute graft-versus-host disease (aGVHD) (p=0.028), but not with malignancy status (54/70 [77.1%] vs. 577/760 [75.9%] malignant; p=0.819); haploidentical (vs. related) donor type remained independent on multivariable analysis (adjusted OR 2.01, 95% CI 1.18-3.41, p=0.0098). CMV monoinfection was associated with adult age and haploidentical transplantation; EBV monoinfection with pediatric age, non-malignant disease, and aGVHD. Pediatric 3-year overall survival (OS) was superior (78.4% vs. 64.6%; median follow-up 41.8 months). The difference in 3-year OS between co-infected (67.3%) and non-co-infected (70.9%) patients did not reach statistical significance (Kaplan-Meier log-rank p = 0.4046; crude mortality by Pearson chi-square, p = 0.286); chronic GVHD was the only independent predictor of OS (adjusted HR 0.016, 95% CI 0.002-0.150, p=0.0003). CMV and EBV post-HCT exhibit distinct, age-associated risk profiles, and co-infection defines a high-risk phenotype linked to intensive immunosuppression and aGVHD. Three-year OS did not differ significantly between groups; given the observational design, selection bias from non-uniform EBV testing, and possible type II error, this should not be taken as evidence that pre-emptive strategies eliminate the survival impact of co-infection. Findings support age- and risk-adapted viral monitoring.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cell Therapy and Applied Genomics, King Hussein Cancer Center, Amman, Jordan.",
    "Faculty of Allied Medical Sciences, Applied Science University, Amman, Jordan.",
    "Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.",
    "Artificial Intelligence and Data Innovation Office, King Hussein Cancer Center, Amman, Jordan."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Osama Alsmadi"
    },
    {
      "affs": [
        2
      ],
      "name": "Hasan Hashem"
    },
    {
      "affs": [
        2
      ],
      "name": "Khalid Halahleh"
    },
    {
      "affs": [
        2
      ],
      "name": "Jude Jarrah"
    },
    {
      "affs": [
        0
      ],
      "name": "Yazan Talab"
    },
    {
      "affs": [
        3
      ],
      "name": "Iyad Sultan"
    },
    {
      "affs": [
        0
      ],
      "name": "Maysa Al-Hussaini"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5qxejsbe8gcp3.bib",
  "cited_by": 0,
  "doi": "10.3389/fcimb.2026.1793798",
  "fulltext_url": "https://europepmc.org/articles/PMC13713334",
  "id": "5qxejsbe8gcp3",
  "issns": [
    "2235-2988"
  ],
  "landing_url": "https://europepmc.org/article/MED/42952612",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2713|Cytomegalovirus and herpesvirus research"
    ]
  ],
  "openalex": "W7221776230",
  "pdf_url": "https://europepmc.org/articles/PMC13713334?pdf=render",
  "pmcid": "PMC13713334",
  "pmid": "42952612",
  "published": "2026-10-14",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/5qxejsbe8gcp3.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:41Z",
      "native_id": "MED:42952612",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42952612"
    },
    {
      "first_seen": "2026-10-31T12:23:54Z",
      "native_id": "PMC13713334",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fcimb.2026.1793798"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Cytomegalovirus and herpesvirus research",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Divergent CMV and EBV co-infection impact in adult and pediatric hematopoietic stem cell transplantation recipients.",
  "title_text": "Divergent CMV and EBV co-infection impact in adult and pediatric hematopoietic stem cell transplantation recipients.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:21:01Z",
  "url": "https://research.draconitic.com/paper/5qxejsbe8gcp3",
  "venue": "Frontiers in cellular and infection microbiology",
  "versions": []
}