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Infectious complications following allogeneic stem cell transplantation by using anti‐thymocyte globulin‐based myeloablative conditioning regimens in children with hemoglobinopathies
Author(s) -
Goussetis E.,
Efstathiou E.,
Paisiou A.,
Avgerinou G.,
Zisaki K.,
Giamouris V.J.,
Peristeri I.,
Kitra V.,
Vessalas G.,
Gamaletsou M.N.,
Sipsas N.V.,
Graphakos S.
Publication year - 2015
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.12358
Subject(s) - medicine , cumulative incidence , transplantation , anti thymocyte globulin , population , immunology , hematopoietic stem cell transplantation , hemorrhagic cystitis , alemtuzumab , gastroenterology , environmental health
Background Anti‐thymocyte globulin ( ATG ) has been used to prevent graft failure/rejection in the setting of allogeneic stem cell transplantation (allo‐ SCT ) for hemoglobinopathies; however, epidemiology data for transplant‐related infections in this population are scarce. Method We retrospectively analyzed the epidemiology of bacterial, fungal, viral, and parasitic infections in a cohort of 105 children and adolescents with β‐thalassemia ( n = 100) or sickle cell disease ( n = 5) who underwent allo‐ SCT using human leukocyte antigen ( HLA )‐identical sibling ( n = 96) or HLA ‐compatible unrelated donors ( n = 9) in a single institution. All patients received an ATG ‐based conditioning regimen. Results The cumulative incidence of cytomegalovirus ( CMV ) viremia was 45.7% (95% confidence interval [ CI ] 33–55%), developing at a median of 48 (range 12–142) days without evidence of overt CMV disease. Herpes zoster developed in 8 patients at a median of 12 months post transplant, while 10 patients presented with late onset hemorrhagic cystitis at a median of 35 days post transplant. The cumulative incidence of bacteremia was 17.1% (95% CI 10.6–25%), occurring at a median of 74 (range 24–110) days. No patient developed probable or definite invasive fungal infection. Four deaths were recorded; 2 of them were attributed to infections (toxoplasmosis and Pneumocystis jirovecii pneumonia, respectively). Conclusion The rate of infections after allo‐ SCT , using an ATG ‐containing preparative regimen, in our population of pediatric patients with hemoglobinopathies is comparable to that reported elsewhere with the use of non‐ ATG containing regimens.