Increased risk of infections and infection-related mortality in children undergoing haematopoietic stem cell transplantation compared to conventional anticancer therapy: a multicentre nationwide study

Abstract

This nationwide multicentre study analysed the epidemiology of bacterial, viral and fungal infections in paediatric haematopoietic stem cell transplantation (HSCT) and paediatric haematology and oncology (PHO) patients over a period of 24 consecutive months, including incidence, hazard risk and outcome of infections as well as occurrence of multidrug-resistant bacteria. During this period, 308 HSCTs were performed and 1768 children were newly diagnosed for malignancy. Compared to PHO, the risk in HSCT patients was significantly higher for all infections (hazard ratio (HR) 2.7), bacterial (HR 1.4), fungal (HR 3.5) and viral (HR 15.7) infections. The risk was higher in allo- than auto-HSCT for bacterial (HR 1.4), fungal (HR 3.2) and viral (HR 17.7) infections. The incidence of resistant bacteria was higher in HSCT than in PHO patients for both G-negative (72.5% vs. 59.2%) and G-positive (41.4% vs. 20.5%) strains. Cumulative incidence of bacterial, fungal and viral infections in HSCT patients was 33.9, 22.8 and 38.3%, respectively. Cumulative incidence of viral infections in allo-HSCT was 28.0% for cytomegalovirus, 18.5% for BK virus, 15.5% for Epstein-Barr virus, 9.5% for adenovirus, 2.6% for varicella zoster virus, 0.9% for influenza, 0.9% for human herpesvirus 6 and 0.3% for hepatitis B virus. Survival rates from infections were lower in HSCT than in PHO patients in bacterial (96.0 vs. 98.2%), fungal (75.5 vs. 94.6%) and most viral infections. In conclusion, the risk of any infections and the occurrence of resistant bacterial strains in allo-HSCT patients were higher than in auto-HSCT and PHO patients, while the outcome of infections was better in the PHO setting.

Antibiotic prophylaxis in neutropenic children with acute leukemia: Do the presently available data really support this practice?

“…Gram-negatives, represent the major threat for neutropenic patients because of a bad prognosis in the case of invasive disease. 23,[26][27][28][29][30][31][32][33] Even if the results of the major RCTs and meta-analyses suggest that administration of antibacterial prophylaxis for febrile neutropenia had no impact on the selection of resistant bacteria, it must be remembered that RCTs, and meta-analyses derived from them, should not be used for epidemiological purposes since a RCT generally did not collect data on infections occurring after the end of the study and in patients excluded from the trial itself. 1,34,35 Therefore, no data on patients (and on the environmental ecology) outside the study were available.…”

Epidemiology and outcome of invasive fungal disease in children after hematopoietic cell transplantation or treated for malignancy: Impact of national programme of antifungal prophylaxis

“…In 2012, the programme of monitoring of infections in children treated for malignancy in chemotherapy (PHO) and transplant (HCT) settings in biennial programs (iPhot‐13, iPhot‐15, iPhot‐17: infections in Polish paediatric hematology, oncology and stem cell transplantation) was started in Poland . Ministry of Health in Poland introduced the refund by National Health Fund the use of posaconazole and voriconazole for prophylaxis in children on chemotherapy for acute myeloid leukaemia (AML), high‐risk or relapsed acute lymphoblastic leukaemia (ALL), myelodysplastic syndromes (MDS), in graft‐vs‐host disease (GVHD) after HCT (from 1‐May‐2014) and in secondary prophylaxis after HCT (from 1‐September‐2014).…”

Cytomegalovirus Infection and Treatment in Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Study from a Single Institution in an Endemic Area

“…Nonetheless, the morbidity and mortality that are associated with allo-HSCT limit its clinical application and efficacy. In addition to graft-versus-host disease (GVHD), infection remains one of the most important complications after allo-HSCT [4]. The incidence of each infection in allo-HSCT recipients varies depending on the time since transplantation.…”