Infection prophylaxis patterns following pediatric autologous hematopoietic stem cell transplantation: A survey of Pediatric Transplant and Cell Therapy Consortium centers

Falcon, Corey; Broglie, Larisa; Phelan, Rachel; Choi, Sung Won; Auletta, Jeffery J.; Chewning, Joseph H.

doi:10.1111/petr.13821

Cited by 6 publications

(2 citation statements)

References 21 publications

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“…11 In the absence of paediatric-specific guidelines, many centres continue to perform routine viral surveillance for patients undergoing ASCT. 7 Previous general guidelines, predominantly focused on adult patients, recommend against routine screening for AdV, EBV and CMV, considering the low risk of clinically significant infection. [3][4][5] Our data support moving away from routine surveillance to a clinically driven approach in children undergoing…”

Section: Discussionmentioning

confidence: 99%

“…As such, the role of routine viral surveillance in ASCT is less clear. In the absence of consensus paediatric guidelines, many centres perform routine weekly testing for viruses in children undergoing ASCT, including CMV and, less commonly, EBV and AdV, with marked variability in practice between centres 7 . At our institution, weekly viral surveillance for CMV, EBV and AdV has been performed for all children undergoing ASCT since 2011.…”

Section: Introductionmentioning

confidence: 99%

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Assessing the utility of routine viral surveillance performed in children undergoing autologous stem cell transplantation at a single centre

Foley

Wong

Keane

et al. 2022

Pediatric Blood & Cancer

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We assessed the utility of routine viral surveillance for cytomegalovirus, Epstein–Barr virus and human adenovirus in children <16 years, undergoing autologous stem cell transplantation (ASCT) at a single centre over a 10‐year period. A total of 85 ASCT were performed in 65 patients. Routine viral surveillance resulted in a high number of tests performed (median 20 tests per ASCT), without any clinically significant viral detections. These data support the limited clinical utility of routine viral surveillance in children undergoing ASCT. Adopting a clinically driven approach for viral testing is likely to be both cost‐effective and safe.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessing the utility of routine viral surveillance performed in children undergoing autologous stem cell transplantation at a single centre

Foley

Wong

Keane

et al. 2022

Pediatric Blood & Cancer

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Invasive fungal infections are rare in pediatric and young adult autologous hematopoietic stem cell transplant patients

Koo,

Huber,

Badia

et al. 2024

Pediatric Blood & Cancer

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BackgroundPediatric and young adult patients undergoing autologous hematopoietic stem cell transplant (auto‐HSCT) face a crucial, yet understudied, risk of invasive fungal infections (IFI), especially compared to allogeneic transplants. This gap underscores the need for research in pediatric patients undergoing auto‐HSCT. Our objective was to evaluate the incidence of IFI in pediatric and young adult patients during the first year after auto‐HSCT.Materials and methodsWe conducted a single‐center retrospective analysis of 150 pediatric and young adult auto‐HSCT patients who underwent transplant from January 2013 to January 2023. We focused on IFI incidence within the first‐year post transplant, using the European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria for IFI identification.ResultsAmong the 150 patients analyzed, with 240 unique transplant episodes, the primary indication was neuroblastoma (37.3%), and micafungin was extensively used for prophylaxis (82.7%). There was an absence of IFI from yeast and mold species, suggesting a low IFI risk in this cohort. The incidence of IFI in pediatric auto‐HSCT recipients receiving micafungin primary antifungal prophylaxis is rare.ConclusionsThe findings advocate for further research to refine prophylaxis guidelines and highlight the need for individualized risk assessment to optimize post‐transplant care.

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High infection rates and risk‐adapted prevention strategies in contemporary pediatric allogeneic hematopoietic stem cell transplantation

Yeung,

Chan,

Wong

et al. 2024

Pediatric Discovery

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With recent changes in hematopoietic stem cell transplantation (HSCT) practices, such as the increasing use of alternative donors and ex vivo T‐cell depletion, how various risk factors interplay and affect the timeline of infections have not been well elucidated. We retrospectively reviewed the first 100 consecutive HSCT from April 2019 to October 2021 in the only pediatric HSCT center in Hong Kong. We found that the vast majority of the allogeneic transplant recipients (69/74, 93.2%) had infections after HSCT, amongst which bacterial, viral, and fungal infection rates were 35.1%, 90.5%, and 9.5%, respectively. In contrast, only 30.8% (8/26) of autologous transplant recipients had infections (rate of bacterial, viral, and fungal infection were 19.2%, 15.4%, and 3.8%, respectively). Human herpesvirus 6 (HHV‐6) and BK virus (BKV) typically occurred early after HSCT, adenovirus (ADV) and varicella zoster virus (VZV) thereafter, and cytomegalovirus (CMV) and Epstein–Barr virus (EBV) throughout the entire 2.5‐year observation period. Ex vivo T‐cell depletion was a general risk factor for viral infection with HHV‐6 (hazard ratio [HR] = 3.03), BKV (HR = 3.36), CMV (HR = 4.45), and EBV (HR = 7.15); all p < 0.02. Cancer in second‐complete remission compared with first‐complete remission was a risk factor for bacterial infection (OR = 6.0, 95% CI = 1.12–32.2, and p = 0.037). Patients with gut graft‐versus‐host disease were at risk for fungal infections (OR = 12.3, 95% CI = 1.33–114.4, and p = 0.027). The infection‐related mortality rate was 10.0%, which occurred only in allogeneic HSCT patients with hematological malignancies receiving cord blood (n = 4) or haploidentical HSCT (n = 6). Collectively, our findings in pediatric patients after contemporary HSCT support both time‐dependent and risk‐adapted measures against infective complications to improve transplant outcome.

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Infection prophylaxis patterns following pediatric autologous hematopoietic stem cell transplantation: A survey of Pediatric Transplant and Cell Therapy Consortium centers

Cited by 6 publications

References 21 publications

Assessing the utility of routine viral surveillance performed in children undergoing autologous stem cell transplantation at a single centre

Assessing the utility of routine viral surveillance performed in children undergoing autologous stem cell transplantation at a single centre

Invasive fungal infections are rare in pediatric and young adult autologous hematopoietic stem cell transplant patients

High infection rates and risk‐adapted prevention strategies in contemporary pediatric allogeneic hematopoietic stem cell transplantation

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