Infectious Complications during Tandem High-Dose Chemotherapy and Autologous Stem Cell Transplantation for Children with High-Risk or Recurrent Solid Tumors

Abstract

We retrospectively analyzed infectious complications during tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) in children and adolescents with high-risk or recurrent solid tumors. A total of 324 patients underwent their first HDCT/auto-SCT between October 2004 and September 2014, and 283 of them proceeded to their second HDCT/auto-SCT (a total of 607 HDCT/auto-SCTs). During the early transplant period of 607 HDCT/auto-SCTs (from the beginning of HDCT to day 30 post-transplant), bacteremia, urinary tract infection (UTI), respiratory virus infection, and varicella zoster virus (VZV) reactivation occurred in 7.1%, 2.3%, 13.0%, and 2.5% of HDCT/auto-SCTs, respectively. The early transplant period of the second HDCT/auto-SCT had infectious complications similar to the first HDCT/auto-SCT. During the late transplant period of HDCT/auto-SCT (from day 31 to 1 year post-transplant), bacteremia, UTI, and VZV reactivation occurred in 7.5%, 2.5%, and 3.9% of patients, respectively. Most infectious complications in the late transplant period occurred during the first 6 months post-transplant. There were no invasive fungal infections during the study period. Six patients died from infectious complications (4 from bacterial sepsis and 2 from respiratory virus infection). Our study suggests that infectious complications are similar following second and first HDCT/auto-SCT in children.

Epidemiology and management burden of invasive fungal infections after autologous hematopoietic stem cell transplantation: 10‐year experience at a European Pediatric Cancer Center

“…Similar to other paediatric populations at risk to develop IFDs, the natural incidence of proven and probable IFDs following autologous HSCT in children and adolescents is difficult to determine due to the widespread use of primary antifungal prophylaxis and empirical antifungal therapy and different practices among institutions to pursue a microbiological diagnosis. Considering these limitations, contemporary incidence rates of proven or probable IFDs range from 0% to 5.2% , , and those of possible mould infections, if analysed, from 0% to 11.8% . The absence of proven or probable IFDs and the rate of 8.7% of possible mould infections observed in our analysis are well in line with the published experience and comparable to these studies as both patient population and key indices of transplant‐associated morbidity such as time to neutrophil engraftment, rates of invasive bacterial infections, and overall mortality through day + 30, are very similar.…”

“…In a further large retrospective cohort study including 607 episodes of autologous HSCT in children with high‐risk or recurrent solid tumours between 2004 and 2014 reported from Seoul, South Korea, no proven or probable IFDs were observed within the first 30 days; the majority of patients (92.4%) received an antifungal agent as prophylaxis (84.3%) or empirically (8.1%). The median time to engraftment was 10 days; within the first 30 days post‐transplant, non‐fungal infections were noted in 24.9%, and overall mortality at this time point was 0.5% …”

“…Since the number of paediatric patients with an indication for autologous HSCT is comparatively low, epidemiological data for IFDs is limited. Among 12 paediatric studies with retrievable incidence data published from 2000 onward and covering the period between 1986 and 2016, rates of proven and probable IFDs within the first 100 days postautologous HSCT ranged from 0% to 8% , and those of possible IFDs from 0 to 11.8 with median rates of 3 and 2.5%, respectively; the relative proportions of yeast and mould IFDs among the proven and probable cases was variable. More contemporary larger studies including both autologous and allogeneic HSCT recipients transplanted mostly in or after 2000 document a lower overall incidence of proven and probable IFDs after autologous HSCT (5.2%, 2.6%, 5% vs 15.5%, 13.9%, 13.0%, respectively) and a lower overall mortality rate compared with allogeneic HSCT where reported .…”

“…Few studies specifically focused on the infectious morbidity in paediatric patients postautologous HSCT, assessing infection rates for epidemiological purposes or as endpoints of interventional studies, or specifically assessing the epidemiology of IFD in this setting …”

Breakthrough invasive candidiasis in pediatric patient with Ewing’s sarcoma: dinical case report and literature review

“…Случаи инвазивных микозов (ИМ) при терапии солидных опухолей у детей описываются как спорадические и, по данным зарубежных эпидемиологических исследований, в среднем составляют 4,6 (0,5-12) %, при этом частота инвазивного кандидоза (ИК) -1,6 % [3,4]. Основным фактором риска ИМ у пациентов с неонкогематологическими заболеваниями является постцитостатическая аплазия кроветворения, степень и длительность которой определяется объемом проводимой химиотерапии [5][6][7]. Следует подчеркнуть нередкую недооценку риска ИМ у пациентов с солидными опухолями, что влечет за собой позднюю диагностику, неверную трактовку результатов проведенного обследования и позднюю антифунгальную терапию, что ухудшает результаты лечения [5].…”