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Febrile complications in the first 100 days after bone marrow transplantation in children: a single center's
M Dell'Orto1, A Rovelli, A Barzaghi
1Università di Milano, Ospedale San Gerardo, Monza, Italy.
Insights
Fever after bone marrow transplantation (BMT) is common, with pneumonia being a major cause of death. Early diagnosis and better tools are crucial for reducing mortality in pediatric BMT recipients.
Area of Science:
- Pediatric Hematology
- Transplant Immunology
- Infectious Diseases
Background:
- Fever is a frequent complication in children post-bone marrow transplantation (BMT).
- Understanding the causes and outcomes of febrile episodes is critical for improving survival rates.
Purpose of the Study:
- To analyze the incidence, causes, and mortality associated with febrile episodes in children within 100 days of BMT.
- To identify risk factors for specific febrile complications like fever of undetermined origin (FUO) and pneumonia.
Main Methods:
- Retrospective analysis of 156 febrile episodes in 102 children undergoing BMT.
- Utilized Cox regression model to assess the impact of graft-versus-host disease (GVHD) and donor type on febrile episodes.
Main Results:
- Fever of undetermined origin (FUO) accounted for 40.3% of febrile episodes; pneumonia occurred in 19.2%.
- Overall mortality was 22.6%, with pneumonia being the leading cause of death (90% of infection-related deaths).
- Graft-versus-host disease (GVHD) significantly increased the risk of FUO (approx. ninefold), while unrelated or mismatched family donors increased pneumonia risk (fourfold).
Conclusions:
- Pneumonia is a critical determinant of mortality in pediatric BMT recipients.
- Improved diagnostic tools are essential for earlier and more precise identification of febrile episodes to reduce early mortality post-BMT.
Abstract:
One hundred fifty-six episodes of fever occurred in 102 children during the first 100 days after bone marrow transplantation (BMT) performed at a single institution: fever of undetermined origin (FUO), 40.3%; septicemia, 7.1%; pneumonia, 19.2%; other infections, 33.4% of cases. The overall incidence of mortality was 22.6% and of mortality due to infections 17.4%. All FUO episodes resolved. Pneumonia was the major cause of death; 60% of recipients who developed pneumonia died, accounting for 90% of deaths attributable to febrile complications. Interstitial pneumonia, occurred rarely, in 3.9% of all febrile episodes. The Cox model showed that the presence of graft-versus-host disease (GVHD) was related to an approximately ninefold increase in the risk of a first episode of FUO (P value .03). The risk of developing pneumonia was fourfold greater in children who received a transplant from a matched unrelated donor or a mismatched family donor (P value .01). Developments in diagnostic tools are needed to diagnose febrile episodes earlier and more precisely with the aim of reducing early mortality after BMT.