Serological Response Following BNT162b2 Anti-Sars-Cov-2 mRNA Vaccination in Hematopoietic Stem Cell Transplantation Patients

Invasive Fungal Infections in Recipients of Hematopoietic Stem Cell Transplants: Results From a Single Center Retrospective Analysis

The purpose of our study was to evaluate the incidence and outcome of invasive fungal infection (IFI) among patients who underwent autologous or allogeneic hematopoietic stem cell transplantation (HSCT) at 11 Italian transplantation centers. This cohort-retrospective study, conducted during 1999-2003, involved HSCT patients admitted to 11 tertiary care centers or university hospitals in Italy, who developed IFIs (proven or probable). Among 3228 patients who underwent HSCT (1249 allogeneic HSCT recipients and 1979 autologous HSCT recipients), IFI occurred in 121 patients (overall incidence, 3.7%). Ninety-one episodes (2.8% of all patients) were due to molds, and 30 (0.9%) were due to yeasts. Ninety-eight episodes (7.8%) occurred among the 1249 allogeneic HSCT recipients, and 23 (1.2%) occurred among the 1979 autologous HSCT recipients. The most frequent etiological agents were Aspergillus species (86 episodes) and Candida species (30 episodes). The overall mortality rate was 5.7% among allogeneic HSCT recipients and 0.4% among autologous HSCT recipients, whereas the attributable mortality rate registered in our population was 65.3% (72.4% for allogeneic HSCT recipients and 34.7% for autologous HSCT recipients). Etiology influenced the patients' outcomes: the attributable mortality rate for aspergillosis was 72.1% (77.2% and 14.3% for allogeneic and autologous HSCT recipients, respectively), and the rate for Candida IFI was 50% (57.1% and 43.8% for allogeneic and autologous HSCT recipients, respectively). IFI represents a common complication for allogeneic HSCT recipients. Aspergillus species is the most frequently detected agent in these patients, and aspergillosis is characterized by a high mortality rate. Conversely, autologous HSCT recipients rarely develop aspergillosis, and the attributable mortality rate is markedly lower. Candidemia was observed less often than aspergillosis among both allogeneic and autologous HSCT recipients; furthermore, there was no difference in either the incidence of or the attributable mortality rate for candidemia among recipients of the 2 transplant types.

Incidence and Risk Factors of Skin Cancer and Preneoplastic Lesions after Autologous and Allogeneic Hematopoietic Cell Transplantation.

Bacterial bloodstream infections (BSIs) are a serious complication after hematopoietic stem cell transplantation (HSCT), especially when caused by multidrug-resistant (MDR) bacteria. However, data on BSIs post-HSCT from centers in sub-Saharan Africa are limited. This study aims to describe the incidence, etiology, and outcomes of BSIs, including those caused by carbapenem-resistant Enterobacterales (CRE), in both autologous and allogenic HSCT recipients in South Africa. Furthermore, this study examines the incidence and clinical impact of colonization with CRE. A retrospective analysis was performed on clinical data from HSCT recipients, transplanted between January 2018 and December 2023 at Groote Schuur Hospital (GSH) and Red Cross War Memorial Children's Hospital, the academic hospitals of the University of Cape Town. Data were extracted from the transplant unit electronic and paper patient records, Hematology Patient Registry, and the National Health Laboratory Service electronic database. Surveillance cultures were taken upon admission and subsequently repeated weekly for GSH patients. In total, 270 HSCT recipients were included: 145 underwent autologous HSCT, and 124 an allogenic HSCT. The most common indication for autologous HSCT was multiple myeloma (52%), while acute myeloid leukemia was the most frequent for allogenic HSCT (34%). The overall incidence of BSIs was 35%, with a higher rate observed in allogeneic HSCT recipients (48%) compared to autologous HSCT recipients (23%). Gram-negative bacteria were the most common pathogens, and CRE were responsible for 9% of BSIs. Carbapenem-resistant Klebsiella pneumonia spp. was the most common CRE found in BSI and rectal surveillance cultures. Surveillance cultures with CRE were detected in 19% of the HSCT recipients during admission to the transplant unit, with oxacillinase-48 (and variants) the most prevalent carbapenemase. Colonization by CRE was an independent risk factor for developing BSIs. Within 100 days post-HSCT, 25 HSCT recipients (9%) died, of whom nine (36%) had a BSI in the last 7 days of life. Bivariate analysis revealed that BSIs significantly reduced overall survival in both autologous and allogenic HSCT recipients, with a further decrease in survival when the BSI was caused by MDR bacteria. BSIs are a frequent and severe complication among HSCT recipients in South Africa, particularly in those receiving allogenic HSCT. Colonization with CRE significantly increases the risk of BSIs, underscoring the need for vigilant infection control and targeted antimicrobial strategies in this vulnerable population.

Risk Factors and Outcomes of Nocardiosis in Hematopoietic Stem Cell Transplantation Recipients

Background Allogeneic and autologous hematopoietic stem cell transplantation (HSCT) are potential curative treatments for several hematological malignancies (1). Survival after HSCT has improved over the last decade, but survivors remain at risk for health issues after transplantation. Cardiovascular complications after HSCT are increasingly recognized (2). Cardiovascular diseases may be an important cause of mortality and morbidity in patients after HSCT owing to the toxicities of the cancer therapies; however, the incidence of cardiovascular events (CVEs) in this population has not been completely characterized. The objective of this systematic review is to summarize the evidence on the incidence of CVEs in HSCT recipients. Methods Medline and Embase were searched from inception to December 2020 without language restriction. Two authors independently screened the titles and abstracts. Inclusion criteria were: cohort studies and phase 3 randomized controlled trials that reported CVEs (i.e., heart failure, arrythmias, acute coronary syndrome, and stroke) or cardiovascular death among adults who underwent HSCT for a hematological malignancy. All-cause mortality, relapse-related mortality, and non-relapse-related mortality (NRM) were also collected. Studies in which the follow up period was not started immediately after HSCT were excluded due to the risk of immortal bias. Results Of 8151 nonduplicate articles, 30 studies including 14019 individuals post autologous HSCT, and 22 studies including 31049 individuals post allogeneic HSCT met the inclusion criteria. The cumulative incidence of CVEs in the first 100 days post autologous HSCT was 9% and arrhythmia (i.e., atrial fibrillation) was the most common CVE. In recipients of allogeneic HSCT, the 100-day cumulative incidence of CVEs was 3%, and heart failure (HF) was the most common reported CVE. In recipients of autologous and allogeneic HSCT, cardiovascular death was responsible for 43% and 10% of NRM within 100 days, respectively (Table 1). The incidence of CVEs was 4.96 per 1000-person years (95% CI; 4.21–5.80) in long-term survivors (beyond 100-days) of autologous HSCT, and HF was the most common CVE in this population. In long-term survivors of allogeneic HSCT, the incidence of CVEs was 1.90 per 1000-person years (95% CI: 1.59–2.24). Cardiovascular death was the most frequently reported CVE in long-term survivors of allogeneic HSCT (Table 2). Conclusion CVEs remain a major cause of non relapse morbidity and mortality in recipients of HSCT, especially recipients of autologous HSCT within the first 100 days. Future studies are needed to identify the risk factors for CVEs that are specific to HSCT recipients. Funding Acknowledgement Type of funding sources: None.

Clinical Characteristics and Outcomes of COVID-19 in Pediatric and Early Adolescent and Young Adult Hematopoietic Stem Cell Transplant Recipients: A Cohort Study

Hematopoietic stem cell transplantation (HSCT) recipients may be at an elevated risk of developing active tuberculosis infection due to suppression in the cellular immune system. Herein, we aimed to evaluate the prevalence of latent tuberculosis and active tuberculosis in patients with allogeneic and autologous HSCT. In this cohort, data were obtained retrospectively from patients' records. The patients who were followed up in the bone marrow transplantation unit of the University of Health Sciences Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital between January 2016 and December 2019 were screened for the study. And the HSCT recipients who had tuberculin skin test and/or QuantiFERON-TB gold (QFT-GIT) test results were included in the study. A total of 361 patients were included in the study, 227 patients had autologous HSCT, and 134 patients had allogeneic HSCT. QFT-GIT was performed in 10 patients with allogeneic HSCT, and it was found positive in only 1 patient. Tuberculin skin test ≥5 mm was accepted as positive and was accepted to have latent tuberculosis, and it was positive in 18.2% (41) of the patients with autologous HSCT and was positive in 21.6% (29) of the patients with allogeneic HSCT. There was no significant difference between the 2 groups (P = .429). Isoniazid (INH) prophylaxis was started in 16.7% of patients with autologous HSCT and 22.4% of patients with allogeneic HSCT. During follow-up, active tuberculosis did not develop in any patients in both groups. There was no statistically significant difference found between allogeneic and autologous HSCT recipients regarding the prevalence of latent tuberculosis. Active tuberculosis infection did not develop in any of the patients who started INH prophylaxis. INH prophylaxis seems to be very efficient in preventing the reactivation of latent tuberculosis in patients going through allogeneic HSCT and/or autologous HSCT.

COVID-19 and Stem Cell Transplantation; Results from the Prospective Survey By the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation (EBMT) and the Spanish Hematopoietic Stem Cell Transplantation and Cell Therapy Group (GETH)

Sounding the alarm on deaths from suicide and accidents after hematopoietic stem cell transplantation

Cervical Papanicolaou Smears in Hematopoietic Stem Cell Transplant Recipients: High Prevalence of Therapy-Related Atypia during the Acute Phase

Impact Of Systemic Antibiotic Prophylaxis In Hematopoietic Stem Cell Transplantation Recipients. A Meta-Analysis Of Randomized Controlled Trials

Increased Incidence of Venous Thromboembolism Following Allogeneic Compared with Autologous Hematopoietic Stem Cell Transplantation.

High Incidence of Invasive Fungal Infections in Adult Patients Undergoing Hematopoietic Stem Cell Transplantation.

ABSTRACTBACKGROUND:Hematopoietic stem cell transplantation (HSCT) recipients requiring intensivecare unit (ICU) admission early after transplantation have a poor prognosis.However, many studies have only focused on allogeneic HSCT recipients.OBJECTIVES:To describe the characteristics of HSCT recipients admitted to the ICUshortly after transplantation and assess differences in 1-year mortalitybetween autologous and allogeneic HSCT recipients.DESIGN AND SETTING:A single-center retrospective cohort study in a cancer center in Brazil.METHODS:We included all consecutive patients who underwent HSCT less than a yearbefore ICU admission between 2009 and 2018. We collected clinical anddemographic data and assessed the 1-year mortality of all patients. Theeffect of allogeneic HSCT compared with autologous HSCT on 1-year mortalityrisk was evaluated in an unadjusted model and an adjusted Cox proportionalhazard model for age and Sequential Organ Failure Assessment (SOFA) atadmission.RESULTS:Of the 942 patients who underwent HSCT during the study period, 83 (8.8%)were included in the study (autologous HSCT = 57 [68.7%], allogeneic HSCT =26 [31.3%]). At 1 year after ICU admission, 21 (36.8%) and 18 (69.2%)patients who underwent autologous and allogeneic HSCT, respectively, haddied. Allogeneic HSCT was associated with increased 1-year mortality(unadjusted hazard ratio, HR = 2.79 [confidence interval, CI, 95%,1.48–5.26]; adjusted HR = 2.62 [CI 95%, 1.29–5.31]).CONCLUSION:Allogeneic HSCT recipients admitted to the ICU had higher short- andlong-term mortality rates than autologous HSCT recipients, even afteradjusting for age and severity at ICU admission.