Infections of the Central Nervous System after Unrelated Donor Umbilical Cord Blood Transplantation or Human Leukocyte Antigen–Matched Sibling Transplantation

Abstract

We analyzed the incidence, clinical characteristics, prognostic factors, and outcome of central nervous system (CNS) infections in consecutive patients with receiving umbilical cord blood transplantation (UCBT) (n = 343) or HLA-matched sibling donor stem cell transplantation (MST) (n = 366). Thirty-four CNS infections were documented at a median time of 116 days after transplantation (range, 7 to 1161). The cumulative incidence (CI) risk of developing a CNS infection was .6% at day +30, 2.3% at day +90, and 4.9% at 5 years. The 5-year CI of CNS infection was 8.2% after UCBT and 1.7% after MST (P < .001). The causative micro-organisms of CNS infections were fungi (35%), virus (32%), Toxoplasma spp. (12%), and bacteria (12%). Fungal infections occurred in 11 patients after UCBT and 1 after MST and were due to Aspergillus spp. (n = 8), Cryptococcus neoformans (n = 2), Scedosporium prolificans (n = 1), and Mucor (n = 1). Except for 1 patient, all died from CNS fungal infection. Viral infections occurred in 9 patients after UCBT and 1 after MST and were due to human herpes virus 6 (n = 7), cytomegalovirus (n = 2), and varicella zoster virus (n = 1). CNS toxoplasmosis was diagnosed in 3 patients after UCBT and 1 after MST. Other pathogens were Staphylococcus spp, Nocardia spp, Streptococcus pneumoniae, and Mycobacterium tuberculosis. Twenty of the 34 patients (59%) died from the CNS infection. In multivariable analysis, UCBT and disease stage beyond first complete remission were independently associated with the risk of developing CNS infections. The 5-year overall survival was 19% in patients who developed a CNS and 39% for those who did not (P = .006). In conclusion, our study showed that CNS infections are a significant clinical problem after stem cell transplantation associated with poor survival. They were more frequent after UCBT compared to MST.

Fungal infections of the central nervous system and paranasal sinuses in onco‐haematologic patients. Epidemiological study reporting the diagnostic‐therapeutic approach and outcome in 89 cases

“…In fact, in the 34 centres participating in this study, less than 1 case per centre per year was observed. With regard to the underlying haematological disease, most of the cases were observed in patients with AML and ALL or in recipients of an allogeneic SCT . In most cases, patients had an active disease at the time of the onset of IFI while few cases occurred with a haematological disease in remission or during the consolidation phase.…”

Lomentospora prolificans fungemia in hematopoietic stem cell transplant patients: First report in South America and literature review

“…We found 36 L. prolificans invasive infections in HSCT recipients, including our report. Seven of them were included in case series and individual data were not available . The remaining 29 cases are described in Table .…”

“…Seven of them were included in case series and individual data were not available. 7,[15][16][17] The remaining 29 cases are described in Table 1. There were 6 cases (20.7%) of locally invasive infection, 10 cases of isolated fungemia (34.5%), and 13 cases of disseminated disease (44.8%).…”

Optimizing Stem Cell Therapy after Ischemic Brain Injury

“…66 Interestingly, it was also noted that patients who underwent UC-BSCs transplantation were more prone to CNS infections. 67…”