Allogeneic Hematopoietic Stem Cell Transplant in a Pediatric Patient with Invasive Fungal Infections: Challenges and Indications

Abstract

Prior invasive fungal infection (IFI) in children with malignancies was considered a contraindication for hematopoietic stem cell transplant (HSCT). This review summarizes the current evidence in safety of allogeneic HSCT with prior IFI in children. In adult population, some studies have shown that pre-transplant IFI should not be considered a contraindication to allogeneic HSCT, but, in the pediatric population, there is limited information about safety of HSCT in children with prior IFI. Epidemiological studies in adults with prior IFI show that allogeneic HSCT is safe. There is no sub-analysis in children within these databases. Studies evaluating risk factors for developing IFI in children with allogeneic HSCT have not found that prior IFI is associated with the reactivation of the fungal infection. A proper control of IFI, the correct choice of conditioning regimen, and secondary prophylaxis make allogeneic HSCT feasible in children with prior IFI. There is an urgency of studies in children evaluating other outcomes to establish HSCT safety in children with prior IFI.