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The gut virome in children undergoing hematopoietic cell transplantation is diverse and a site for viral reactivation

Bone Marrow Transplantation (2026) Cite this article

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The role of the gut virome in children undergoing allogeneic hematopoietic cell transplantation (HCT) is unknown. A single prior study of the adult HCT virome showed predominance of Anelloviruses and Picobirnaviruses, the latter predicting acute graft versus host disease (GVHD) [1], but these data cannot be extrapolated to children due to known age-related virome differences [2].

We characterized the pediatric gut virome longitudinally in children <5 years of age undergoing allogeneic HCT and correlated findings with post-HCT clinical outcomes.

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Fig. 1
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Data availability

Sequencing data deposited in SRA: PRJNA1247937 (SUB15240795). For additional data contact Pooja.khandelwal@cchmc.org.

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Acknowledgements

We acknowledge clinical staff, patients and families at Cincinnati Children’s Hospital Medical Center.

Funding

Center for Pediatric Genomics Pilot Award (PK); R01 DK125418 (Laskin/Blackard) NIH/NIDDK; R01 HL171046 (Jodele/Laskin/Blackard) NIH/NHLBI.

Author information

Authors and Affiliations

  1. Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Pooja Khandelwal, Azada Ibrahimova, Aaron Webster, Kelly Lake, Colin Hoerth, Nathan Luebbering, Sheyar Abdullah & Stella M. Davies

  2. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Pooja Khandelwal, David Haslam, Azada Ibrahimova, Aaron Webster, Kelly Lake, Colin Hoerth, Nathan Luebbering, Sheyar Abdullah & Stella M. Davies

  3. Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    David Haslam

  4. Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Benjamin Laskin

  5. Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Jason T. Blackard

Authors
  1. Pooja Khandelwal
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  2. David Haslam
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  3. Azada Ibrahimova
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  4. Benjamin Laskin
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  6. Jason T. Blackard
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  7. Kelly Lake
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  8. Colin Hoerth
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  10. Sheyar Abdullah
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  11. Stella M. Davies
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Contributions

PK designed the study and wrote the manuscript; DH sequenced and analyzed stool virome; BL provided data on urine BK; AW performed statistical analyses; JTB performed BK stool sequencing; KL, NL, SA, CH performed filtration and DNA extraction; AI collected antibiotic data; SMD oversaw the entire study. All authors reviewed the manuscript.

Corresponding author

Correspondence to Pooja Khandelwal.

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Competing interests

PK: Incyte Consultancy. All other authors: no conflicts.

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Khandelwal, P., Haslam, D., Ibrahimova, A. et al. The gut virome in children undergoing hematopoietic cell transplantation is diverse and a site for viral reactivation. Bone Marrow Transplant (2026). https://doi.org/10.1038/s41409-026-02910-4

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