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Analysis of early infectious complications in pediatric patients undergoing bone marrow transplantation
A Busca1, E M Saroglia, M Giacchino
1Department of Pediatrics, University of Turin, Italy. busca@pediatria.unito.it
Insights
Infectious complications are common after pediatric bone marrow transplantation (BMT), especially during neutropenia. Allogeneic BMT recipients face a higher risk of secondary fever, though overall infection mortality remains low.
Area of Science:
- Pediatric Hematology Oncology
- Transplantation Immunology
- Infectious Diseases
Background:
- Bone marrow transplantation (BMT) is a critical treatment for pediatric hematological malignancies, solid tumors, and nonmalignant disorders.
- Infectious complications represent a significant concern following BMT, impacting patient outcomes.
- Understanding the characteristics of these infections is crucial for optimizing patient care.
Purpose of the Study:
- To analyze the incidence and characteristics of infectious complications within the first 100 days post-BMT in pediatric patients.
- To compare infectious complication rates between allogeneic and autologous BMT recipients.
- To identify risk factors and pathogens associated with infection and mortality.
Main Methods:
- Retrospective analysis of 123 pediatric patients undergoing BMT.
- Categorization of patients by malignancy type (hematological, solid tumors, nonmalignant disorders) and transplant type (allogeneic vs. autologous).
- Detailed monitoring for fever, documented infections, bacteremia, and mortality within 100 days post-transplant.
Main Results:
- Fever occurred in 87% of patients, with 82% during neutropenia. Documented infections affected 31%, and possible infections 69%.
- Bacteremia incidence was 21%, predominantly caused by gram-positive cocci. Secondary febrile episodes were significantly higher in allogeneic recipients (40%) versus autologous (15%).
- Infection-related mortality was low (5% for matched sibling donor, 8% for unrelated donor, 0% for autologous). Invasive fungal infections caused 2 of 3 deaths.
Conclusions:
- The majority of pediatric BMT patients experience infectious episodes, with fever being the most common symptom.
- Allogeneic BMT recipients are at a significantly higher risk for secondary febrile episodes compared to autologous recipients.
- Despite the high incidence of infections, the overall mortality rate due to infection within 100 days post-BMT is low, highlighting the effectiveness of supportive care.
Abstract:
The purpose of the present study was to analyze the characteristics of infectious complications occurring during the first 100 days after bone marrow transplantation (BMT) in a cohort of 123 pediatric patients with hematological malignancies (n = 73), solid tumors (n = 32) and nonmalignant disorders (n = 18). Fifty-eight patients received allogeneic grafts, and 65 patients an autologous transplant. Fever developed in 107 (87%) children; 82% of infectious complications occurred during the neutropenic period. Documented infection developed in 33 (31%) patients, while 74 (69%) patients had possible infection (i.e. fever of unknown origin). The incidence of bacteremia was 21%, and gram-positive cocci were the predominant pathogens; non-bacteremic microbiologically documented infection developed in 6% of patients; clinically evident infection developed in 4% of subjects. The incidence of primary febrile episodes was not significantly different between autologous and allogeneic BMT (86% vs 88%); nor did the median number of days to the onset of fever (5 days in both groups) or the median duration of fever (5 days in both groups) differ. In contrast, the frequency of secondary febrile episodes was significantly higher (P = 0.0001) in allogeneic BMT recipients (40%) than in autologous recipients (15%). The mortality rate due to infections was 2/36 (5%) for matched sibling donor BMT, and 1/13 (8%) for matched unrelated donor BMT. No deaths occurred in the 65 patients who were autografted. Invasive fungal infections accounted for 2 of the 3 infectious deaths. In conclusion, the majority of children undergoing BMT experienced at least one infectious episode; allogeneic BMT recipients were at high risk of developing secondary febrile episodes, but the overall mortality rate due to infection in the first 100 days after transplantation was low.