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[Infectious complications postengrafment in the first year after autologous stem cell transplantation in children]
H Ben Salah1, C Coze, J C Gentet
1Service d'oncologie pédiatrique, hôpital d'enfants de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France. hassen.bensalah@planet.tn
Insights
Infections after pediatric stem cell transplantation for solid tumors are uncommon and generally have a good prognosis. Lower CD34(+) cell doses may increase infection risk, highlighting the importance of prophylaxis.
Area of Science:
- Pediatric Hematology/Oncology
- Infectious Diseases
- Stem Cell Transplantation
Context:
- Infectious complications following stem cell transplantation (SCT) in pediatric patients are a significant concern.
- Data on late-onset infections post-engraftment in this population are limited.
- Autologous SCT for solid tumors requires careful monitoring for infectious sequelae.
Purpose:
- To determine the incidence, types, and outcomes of infections in the first year post-engraftment in children undergoing autologous SCT for solid tumors.
- To identify factors associated with the development of late infections after SCT.
- To evaluate the effectiveness of prophylactic antimicrobial regimens.
Summary:
- A retrospective analysis of 84 pediatric patients undergoing autologous SCT for solid tumors revealed that 46% experienced infections within the first year post-engraftment.
- Bacterial septicemia and herpes zoster were the most common infections.
- Lower CD34(+) cell dose (<7.5 x 10(6)/kg) and failure to achieve remission were associated with increased infection risk.
- A history of varicella was a significant predictor for developing zoster infections.
Impact:
- Infections following autologous SCT for solid tumors in children generally have a favorable prognosis.
- Systematic antimicrobial prophylaxis with trimethoprim/sulfamethoxazole (TMP/SMX) is recommended.
- CD34(+) cell dose appears to be a crucial factor in preventing late infections, warranting further investigation.
Background:
Studies on the infectious complications postengrafment in pediatric stem cell transplantation patients are rare. The aim of this study was to assess the incidence, types, outcome and factors affecting late infections.
Patients And Methods:
A single-institution retrospective analysis was done of infections recorded in the first year following engrafment in children who underwent autologous stem cell transplantation for solid tumors from January 1991 to December 2000. A systematic antimicrobial chemoprophylaxis of TMP/SMX was administered. Patients who were at high risk for varicella-zona virus infection received prophylactic acyclovir.
Results:
Eighty-four assessable patients were enrolled. Fifty-four patients (64%) underwent autologous peripheral blood stem cell transplantation and 30 patients (36%) underwent bone marrow transplantation. Forty-nine episodes of infections were documented in 39 patients (46%) of whom 27 patients (32%) developed infections after the first 100 days post transplantation. Bacterial septicemia occurred in nine patients of whom four patients had a catheter-related septicemia. Twelve patients (14%) developed localized herpes zoster infection. Local fungal infection occurred in five patients. Infection-related death occurred in one patient with non-documented pneumonitis. Univariable analysis showed a correlation between the CD34(+) cell dose <7.5 10(6)/kg and the development of infections (P =0.04). Patients who did not go into remission after transplantation where at high risk for septicemia (P =0.007). Multivariate analysis showed that a history of varicella or pretransplant varicella-zona positivity was the only significant factor for development zoster infection (P =0.01).
Conclusion:
Our study shows that infections in the first year postengrafment following autologous stem cell transplantation for solid tumors have a good prognosis and that the use of TMP/SMX should be the single systematic antimicrobial prophylaxis. The CD34(+) cell dose seems to play a role in preventing late infections.
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