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Infections diagnosed in the first year after pediatric stem cell transplantation
Daniel Kelly Benjamin1, William C Miller, Sherry Bayliff
1Department of Pediatrics, Duke University Medical School, Durham, NC, USA. benja005@duke.edu
Insights
Pediatric stem cell transplant (SCT) patients face increased infection risks after 30 days, particularly with unrelated donor transplants. Graft-versus-host disease (GVHD) and neutropenia are key risk factors for specific infections post-SCT.
Area of Science:
- Pediatric Hematology/Oncology
- Infectious Diseases
- Stem Cell Transplantation
Background:
- Infections post-pediatric stem cell transplantation (SCT) are less understood than in adults.
- Risk factors for infection in pediatric SCT patients require further elucidation.
Purpose of the Study:
- To describe the cumulative incidence of infections in the first year post-SCT in pediatric patients.
- To analyze risk factors associated with specific infection types in this cohort.
Main Methods:
- Retrospective cohort study of 485 children undergoing 510 SCTs.
- Recorded infections in the first year, categorized by pathogen type.
- Analyzed incidences based on transplant type and time post-transplant.
- Performed bivariable and multivariable analyses for risk factors including neutropenia and graft-versus-host disease (GVHD).
Main Results:
- No significant difference in infection incidence by transplant type within the first 30 days.
- After 30 days, unrelated cord blood and matched unrelated donor transplants showed higher infection risks (P < 0.001).
- Increased risk of aspergillosis, candidiasis, and adenovirus infections observed with unrelated donor transplants.
- Severe GVHD was linked to aspergillosis (RR 7.5), and neutropenia to gram-negative rod infections.
Conclusions:
- Transplant type impacts infection risk after 30 days in pediatric SCT.
- Specific infections associated with higher mortality are more prevalent with certain transplant types.
- Understanding these risks is crucial for managing pediatric SCT outcomes.
Background:
Cumulative incidence of infections in the first year posttransplantation in adult patients has been well-described. Such description is less than complete for pediatric stem cell transplantation (SCT) patients. Further among those patients who have been infected, analysis of risk factors for infection has not been well-described for a large cohort of pediatric SCT patients.
Methods:
We conducted a retrospective cohort study of infections in the first year after SCT at Duke University Medical Center. We recorded all infections in the first year after transplantation. We determined incidences for 6 categories of infection: gram-negative rods; gram-positive cocci; yeast species; Aspergillus sp.; adenovirus; and cytomegalovirus. We determined incidences based on type of transplant and days post transplantation. We also completed bivariable and multivariable analysis of risk factors [neutropenia, graft vs. host disease (GVHD) and GVHD treatment] for infection type among those children who were infected.
Results:
We evaluated 510 transplants in 485 children. There were 584 infections in the first year after transplantation. During the first 30 days posttransplantation, type of transplantation did not predict incidence of infection or type of infection. After 30 days children who received unrelated cord blood transplant and matched unrelated donor transplant were at much higher risk of infection than were patients who received autologous, matched sibling or haploidentical transplant (P < 0.001). Patients who received unrelated cord blood or matched unrelated donor transplantation were at higher risk of aspergillosis (P = 0.002), candidiasis (P = 0.005) and adenovirus (P < 0.0001) but not cytomegalovirus (P = 0.18). In analysis of risk factors among those infected, patients with aspergillosis were more likely to have severe GVHD: multivariable 1 year risk ratio, 7.5; 95% confidence interval, 3.0, 18.4. Neutropenia was more strongly associated with gram-negative rod infection than any other type of infection.
Conclusions:
The incidence of infection immediately after transplantation did not differ significantly by type of transplant in this pediatric population. Type of transplant predicted increased incidence of infection 30 days posttransplantation and increased incidence of infection with several organisms traditionally associated with a high mortality rate in the transplant population.