Infectious complications following allogeneic stem cell transplantation by using anti‐thymocyte globulin‐based myeloablative conditioning regimens in children with hemoglobinopathies

Abstract

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. 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. 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 12months post transplant, while 10 patients presented with late onset hemorrhagic cystitis at a median of 35days 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). 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.