Proven Invasive Fungal Infection during the Pre-Engraftment Period in Pediatric Allogeneic Hematopoietic Stem Cell Transplantation for Non-Malignant Disorders
Published on: 2019-07-16
Invasive fungal infection remains a significant cause of morbidity and mortality, particularly during the pre-engraftment neutropenic period, in pediatric allogeneic hematopoietic stem cell transplantation. We retrospectively analyzed epidemiology, incidence, and outcome of IFI in children with non-malignant diseases undergoing HSCT during the preengraftment period. Between 2004 and 2014, 236 patients underwent HSCT for non-malignant disorders at Rambam Health Care Campus in Haifa and Hadassah Hebrew University Medical Center in Jerusalem. Main diagnoses were thalassemia and severe immunodeficiency. Eighteen of 236 (7.6%) patients (9 males, 9 females) developed proven IFI. Median age was 5.47 years (0.44-18 years). Invasive candidiasis was seen in nine patients, invasive aspergillosis in five, both invasive candidiasis and invasive aspergillosis in two, Mucor and Fusarium in one patient each. In eight (44.4%) patients, IFI occurred secondary to engraftment failure; two received autologous back-up bone marrow stem cell infusion and survived, three died due to IFI complications, and three were treated with granulocyte transfusion, only two of whom survived. Three patients developed autologous recovery. IFI was the main cause of death in five (27.8%) patients. It was concluded that engraftment failure, thalassemic patients with high serum ferritin levels, and congenital or acquired immunodeficiency exhibited increased susceptibility to pre-engraftment IFI. Granulocyte transfusion and autologous stem cell infusion could be the therapeutic option for life-threatening pre-engraftment IFI. Our data may help guide the intensity of monitoring for prevention, early diagnosis, and treatment of IFI.