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Invasive Fungal Disease in Pediatric Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplant
Catherine Aftandilian1, Kenneth Weinberg, Jennifer Willert
1Divisions of *Pediatric Hematology/Oncology†Stem Cell Transplantation and Regenerative Medicine‡Pediatric Infectious Diseases, Stanford University, Stanford, CA.
Insights
Invasive fungal disease (IFD) after pediatric hematopoietic stem cell transplant (HSCT) affects patients similarly regardless of prior IFD history. However, post-transplant IFD significantly increases mortality risk.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Transplantation Immunology
Background:
- Invasive fungal disease (IFD) is a critical complication following pediatric allogeneic hematopoietic stem cell transplant (HSCT), contributing to significant morbidity and mortality.
- Understanding IFD risk factors and outcomes in this vulnerable population is essential for improving patient survival.
Purpose of the Study:
- To analyze the incidence and outcomes of IFD in pediatric patients undergoing allogeneic HSCT.
- To compare IFD rates and mortality between patients with and without a history of IFD prior to HSCT.
- To evaluate the impact of antifungal prophylaxis on post-transplant IFD rates.
Main Methods:
- Retrospective analysis of 152 pediatric patients who underwent allogeneic HSCT between 2005 and 2012.
- Categorization of patients based on IFD history before HSCT (n=26) and absence of IFD history (n=126).
- Review of antifungal prophylaxis strategies and assessment of post-transplant IFD incidence and all-cause mortality.
Main Results:
- The incidence of IFD post-HSCT was similar in patients with (7.7%) and without (7.1%) prior IFD.
- Mortality rates did not differ significantly between patients with or without prior IFD (35% vs. 28%).
- Patients who developed IFD post-HSCT had significantly higher all-cause mortality (67%) compared to those without post-transplant IFD (21%).
Conclusions:
- Prior history of IFD did not significantly alter the risk of developing IFD after allogeneic HSCT in pediatric patients.
- Post-transplant IFD is associated with a substantially increased risk of mortality.
- Further research into identifying specific risk factors for post-transplant IFD is crucial for enhancing outcomes in pediatric HSCT recipients.
Abstract:
Invasive fungal disease (IFD) remains a major cause of morbidity and mortality in pediatric patients after allogeneic hematopoietic stem cell transplant (HSCT). We analyzed the outcome of 152 consecutive pediatric patients who underwent allogeneic HSCT from 2005 to 2012: 126 of these without a history of IFD and 26 with IFD before HSCT. Antifungal prophylaxis agent was determined by the primary transplant attending. The rate of IFD after HSCT among patients with or without prior IFD was similar (7.7% with and 7.1% without a history of fungal disease before transplant). Mortality in these 2 populations did not differ (35% vs. 28%, P=0.48, χ). Patients deemed at higher risk for IFD were generally placed on voriconazole prophylaxis; however, this did not affect rates of posttransplant IFD. All-cause mortality in patients with posttransplant IFD was significantly higher than those without posttransplant IFD (67% vs. 21%, P<0.0001,χ). Identifying risk factors for posttransplant IFD remains a high priority to improve outcome of HSCT.
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