{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:04:20Z","timestamp":1790665460994,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp;amp; Cancer"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2010associated ITP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Procedures<\/jats:title>\n                    <jats:p>\n                      We conducted a single\u2010center retrospective cohort study of children with ITP, analyzing clinical and laboratory characteristics, treatment, and outcomes in CMV\u2010positive (CMV\n                      <jats:sup>pos<\/jats:sup>\n                      ) and CMV\u2010negative (CMV\n                      <jats:sup>neg<\/jats:sup>\n                      ) patients. Univariable and multivariable logistic regression analyses were performed to evaluate the association between CMV status and remission.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 444 children with ITP, 25 (5.6%) were CMV\n                      <jats:sup>pos<\/jats:sup>\n                      . At diagnosis, CMV\n                      <jats:sup>pos<\/jats:sup>\n                      patients had significantly lower median platelet counts (5\u00a0\u00d7\u00a010\n                      <jats:sup>3<\/jats:sup>\n                      (interquartile range [IQR] (3\u20139)) vs. 11\u00a0\u00d7\u00a010\n                      <jats:sup>3<\/jats:sup>\n                      (IQR 5\u201324)\/\u00b5L,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.01), hemoglobin levels, absolute neutrophil counts, and higher rates of transaminase elevation; nonetheless, bleeding severity was similar. CMV\n                      <jats:sup>pos<\/jats:sup>\n                      patients more frequently received multiple treatment courses at diagnosis (52.2% vs. 17.8%,\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      &lt;\u00a00.001). However, during follow\u2010up at 3\u201312 months from diagnosis, only 8% of CMV\n                      <jats:sup>pos<\/jats:sup>\n                      patients received treatment as compared with 30.6% of CMV\n                      <jats:sup>neg<\/jats:sup>\n                      patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.01), whereas at 12 months remission rates were significantly higher among CMV\n                      <jats:sup>pos<\/jats:sup>\n                      patients (84% vs. 59.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.018). Only one CMV\n                      <jats:sup>pos<\/jats:sup>\n                      patient received antiviral therapy. In univariable and multivariable logistic regression analyses, CMV positivity was independently associated with 12\u2010month ITP remission (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.34\u201312.54 and OR 3.78, 95% CI 1.0004\u201320.16, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CMV\u2010associated ITP is uncommon and follows a characteristic clinical course, marked by early poor treatment response followed by favorable long\u2010term outcomes. Identification of CMV in pediatric ITP patients provides important prognostic information regarding disease trajectory.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70722","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:39:47Z","timestamp":1790663987000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Biphasic Clinical Course of Pediatric Cytomegalovirus\u2010Associated Immune Thrombocytopenia: Early Poor Treatment Response but Favorable Long\u2010Term Outcomes"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0033-3425","authenticated-orcid":false,"given":"Oded","family":"Gilad","sequence":"first","affiliation":[{"name":"Department of Hematology\u2013Oncology Schneider Children's Medical Center of Israel  Petach Tikvah Israel"},{"name":"Gray Faculty of Medical &amp; Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7800-1984","authenticated-orcid":false,"given":"Ohad","family":"Atia","sequence":"additional","affiliation":[{"name":"Department of Hematology\u2013Oncology Schneider Children's Medical Center of Israel  Petach Tikvah Israel"},{"name":"Gray Faculty of Medical &amp; Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Tanous","sequence":"additional","affiliation":[{"name":"Clalit Health Services  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5216-1135","authenticated-orcid":false,"given":"Dafna","family":"Brik Simon","sequence":"additional","affiliation":[{"name":"Department of Hematology\u2013Oncology Schneider Children's Medical Center of Israel  Petach Tikvah Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Dvori","sequence":"additional","affiliation":[{"name":"Department of Hematology\u2013Oncology Schneider Children's Medical Center of Israel  Petach Tikvah Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Hematology\u2013Oncology Schneider Children's Medical Center of Israel  Petach Tikvah Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8120-0439","authenticated-orcid":false,"given":"Tracie A.","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Department of Hematology\u2013Oncology Schneider Children's Medical Center of Israel  Petach Tikvah Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efraim","family":"Bilavsky","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical &amp; Health Sciences Tel Aviv University  Tel Aviv Israel"},{"name":"Infection Disease Unit Schneider Children's Medical Center of Israel  Petach Tikvah Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3763-5694","authenticated-orcid":false,"given":"Joanne","family":"Yacobovich","sequence":"additional","affiliation":[{"name":"Department of Hematology\u2013Oncology Schneider Children's Medical Center of Israel  Petach Tikvah Israel"},{"name":"Gray Faculty of Medical &amp; Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1680-2388","authenticated-orcid":false,"given":"Orna","family":"Steinberg\u2010Shemer","sequence":"additional","affiliation":[{"name":"Department of Hematology\u2013Oncology Schneider Children's Medical Center of Israel  Petach Tikvah Israel"},{"name":"Gray Faculty of Medical &amp; Health Sciences Tel Aviv University  Tel Aviv Israel"},{"name":"Department of Pediatric Hemato\u2010Oncology Dana Dwek Children, Tel Aviv Sourasky Medical Center  Tel Aviv\u2010Yafo Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.25409"},{"issue":"3","key":"e_1_2_11_3_1","first-page":"30","article-title":"Immune Thrombocytopenic Purpura in Children and Adults: A Comparative Retrospective Study in IRAN","volume":"8","author":"Saeidi S.","year":"2014","journal-title":"International Journal of Hematology\u2010Oncology and Stem Cell Research"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1055\/a-2508-1112","article-title":"Primary Versus Secondary Immune Thrombocytopenia (ITP): A Meeting Report From the 2023 McMaster ITP Summit","volume":"125","author":"Modi D.","year":"2025","journal-title":"Journal of Thrombosis and Haemostasis"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102010\u201008\u2010302984"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019000966"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019000812"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.641535"},{"issue":"3","key":"e_1_2_11_9_1","first-page":"139","article-title":"Prevalence of Cytomegalovirus (CMV) and Epstein\u2010Barr Virus (EBV) Subclinical Infection in Patients With Acute Immune Thrombocytopenic Purpura (ITP)","volume":"15","author":"Abbasi F.","year":"2021","journal-title":"International Journal of Hematology\u2010Oncology and Stem Cell Research"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/5584_2015_162"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.5045\/br.2018.53.2.110"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/08880010290097233"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102141.2004.05068.x"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102141.2009.07714.x"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.12659\/AJCR.947070"},{"issue":"12","key":"e_1_2_11_16_1","article-title":"Immune Thrombocytopenic Purpura Secondary to Cytomegalovirus (CMV) Infection: A Clinical Case","volume":"16","author":"Nunes Silva F.","year":"2024","journal-title":"Cureus"},{"issue":"10","key":"e_1_2_11_17_1","article-title":"A Case of Cytomegalovirus Infection With Severe Thrombocytopenia in an Infant Who Was Successfully Managed With Antiviral Therapy","volume":"14","author":"Echcharii N.","year":"2022","journal-title":"Cureus"},{"key":"e_1_2_11_18_1","first-page":"79","article-title":"Immune Thrombocytopenic Purpura Secondary to Cytomegalovirus Infection: A Case Report","volume":"2","author":"Flores\u2010Chang B. S.","year":"2015","journal-title":"Frontiers in Medicine (Lausanne)"},{"issue":"11","key":"e_1_2_11_19_1","first-page":"922","article-title":"Cytomegalovirus\u2010Associated Idiopathic Thrombocytopenic Purpura in Chinese Children","volume":"40","author":"Yu S.","year":"2008","journal-title":"Scandinavian Journal of Infectious Diseases"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiac.2018.06.004"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12288\u2010018\u20100945\u2010x"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1201\u20109712(03)90107\u2010X"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2002.128547"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa030254"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13317\u2010017\u20100097\u20102"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/12.Supplement_7.S727"}],"container-title":["Pediatric Blood &amp; Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1545-5017.70722","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/1545-5017.70722","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1545-5017.70722","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:39:49Z","timestamp":1790663989000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/1545-5017.70722"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":25,"alternative-id":["10.1002\/1545-5017.70722"],"URL":"https:\/\/doi.org\/10.1002\/1545-5017.70722","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"value":"1545-5009","type":"print"},{"value":"1545-5017","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"assertion":[{"value":"2026-05-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70722"}}