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Invasive pneumococcal disease following adult allogeneic hematopoietic stem cell transplantation
Author(s) -
Torda A.,
Chong Q.,
Lee A.,
Chen S.,
Dodds A.,
Greenwood M.,
Larsen S.,
Gilroy N.
Publication year - 2014
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12268
Subject(s) - medicine , cumulative incidence , hematopoietic stem cell transplantation , odds ratio , incidence (geometry) , transplantation , univariate analysis , retrospective cohort study , pneumonia , pediatrics , multivariate analysis , physics , optics
Background Allogeneic hematopoietic stem cell transplantation (allo HSCT ) recipients are at high risk of invasive pneumococcal disease ( IPD ). We investigated the incidence and risk factors of IPD in allo HSCT recipients from 4 regional transplant centers over an 11‐year period. This study aimed to inform future improvements in post‐transplant care. Methods We conducted a retrospective nested 1:2 case–control study in patients aged ≥18 years who underwent allo HSCT between 2001 and 2011 in 4 major allogeneic transplant centers. Controls were matched with IPD cases on the basis of conditioning intensity and donor relationship (related or unrelated). Demographics and clinical characteristics of cases and controls were summarized. Univariate analysis of risk factors in matched case–control sets, and multivariate conditional logistic regression to control for confounding, were performed. Results In 23 allo HSCT recipients, 26 IPD episodes were identified. The cumulative incidence over 11 years was 2.3% (95% confidence interval [ CI ] 1.45–3.15) and the incidence density 956 per 100,000 transplant years of follow‐up (95% CI 580–1321). Multivariate risk factor analysis and backwards elimination showed a significant positive association between mycophenolate mofetil ( MMF ), hyposplenism/asplenia, and IPD , whereas trimethoprim‐sulfamethoxazole ( TMP / SMX ) prophylaxis for P neumocystis jirovecii pneumonia ( PJP ) was associated with lower odds of IPD cases. Of allo HSCT recipients with IPD , 38.5% required intensive care, and, of deaths documented in cases over the period of review, 30% were attributable to IPD . Serotypes causing IPD matched currently available vaccines in 15/22 (68.1%) episodes. Conclusions The incidence of IPD in allo HSCT recipients is an important cause of morbidity and mortality, with rates of disease being many fold higher than the general population. Patients with evidence of hyposplenism/asplenia define a high‐risk group in the allo HSCT population for IPD , and the independent association with IPD and MMF in the adjusted model from this study requires further evaluation. The occurrence of post‐transplant IPD may be reduced by measures such as vaccination with both 13‐valent and 23‐valent pneumococcal vaccines. TMP / SMX prophylaxis for the prevention of PJP may offer incidental protection against IPD in allo HSCT recipients.