Rotavirus infection following post-transplantation cyclophosphamide based haploidentical hematopoietic cell transplantation in children is associated with hemophagocytic syndrome and high mortality.

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We evaluated the incidences and consequences of rotavirus induced diarrhea in a cohort of 115 patients undergoing T-cell replete haploidentical transplantation. Four out of 115 patients developed rotavirus-induced diarrhea between 47 and 147days. The incidence of rotavirus infection was 9.7% in children compared to none in adults (P=.01). Thiswas 25.3% in those with GVHD compared to 1.2% in those withoutGVHD (P=.001). Rotavirus infection was followed by post-transplantation hemophagocytic syndrome (PTHPS) at a median of 4days (range, 3-10days) in all four patients. Three patients succumbed to the complications related to PTHPS. Only one patient, who is long-term survivor, was able to eliminate this virus after 2weeks. Children undergoing T-replete haploidentical hematopoietic cell transplantation who develop GVHD are at a higher risk of community-acquired rotavirus infection which was strongly associated with PTHPS with poor outcome.