42514. Infection Rate after Stem Cell Transplantation for Hemophagocytic Lymphohistiocytosis in Children Receiving Hematopoietic Stem Cell Transplantation
Session: Poster Abstract Session: Medical Student Poster Session
Friday, October 4, 2013
Room: Yerba Buena Ballrooms
Posters
  • HLH poster IDweek final1.pdf (142.1 kB)
  • Background:

    Hemophagocytic lymphohistiocytosis (HLH) diagnoses have recently increased. Stem cell transplantation (SCT) is standard therapy and data on the frequency and types of infection in HLH patients undergoing SCT are limited.

    Methods:

    We retrospectively reviewed age, gender, HLH type (primary or secondary), donor source, and conditioning regimen for 18 HLH patients who underwent SCT from 2000-12. We documented infections and deaths within 6 months of SCT.

    Results:

    Patients had a mean of 1.7 infections (table). Mortality rate was 27.2% (n=5) with 4/5 patients having at least one active infection at death.

     

    Age/ Gender

    HLH type

    Donor source

    Infections within 6 months of SCT

    Alive 6 months post-SCT

    0y6m/ M

    Prim

    URD CBT

    Adenoviremia, a-hemolytic streptococcus*, Norovirus, Rhinovirus

    No**

    0y11m/ F

    Sec

    MRD BMT

    Rhinovirus

    Yes

    12y0m/ F

    Sec

    MUD BMT

    Rhinovirus, Staphylococcus aureus*, Adenoviremia

    Yes

    0y9m/ F

    Sec

    MUD BMT

    CNS fungal infection, not specified

    No**

    1y4m/ F

    Prim

    URD CBT

    CONS*, RSV

    Yes

    0y5m/ F

    Prim

    MRD BMT

    Candida lusitaniae*

    No

    1y0m/ M

    Prim

    URD CBT

    None

    Yes

    1y3m/ F

    Prim

    URD CBT

    Streptococcus mitis*, CONS *

    No**

    1y1m/ F

    Prim

    MRD CBT

    Klebsiella pneumonia*, E. cloacae*, Enterococcus faecalis*, CONS*

    Yes

    0y8m/ F

    Prim

    URD CBT

    CONS*

    Yes

    1y7m/ M

    Prim

    URD CBT

    RSV, Adenoviremia

    Yes

    0y8m/ M

    Prim

    URD CBT

    None

    Yes

    4y0m/ F

    Prim

    MUD BMT

    Rhinovirus

    Yes

    2y0m/ F

    Prim

    MUD BMT

    CMV viremia

    No**

    0y5m/ F

    Prim

    URD CBT

    Mycobacterium kansasii lymphadenitis, CONS* Parainfluenza, HHV-6 viremia

    Yes

    1y0m/ F

    Prim

    URD CBT

    S. mitis*

    Yes

    1y1m/ F

    Prim

    MUD BMT

    None

    Yes

    0y11m/ M

    Prim

    MRD BMT

    C. tropicalis*, E. cloacae*,  CONS*

    Yes

    Prim, primary; Sec, secondary; URD, unrelated; CBT, cord blood transplant; MRD, matched related donor; MUD, matched unrelated donor; BMT, bone marrow transplant; GAFA, gentamicin, amoxicillin, fluconazole, acyclovir; CONS, coagulase negative Stapyhlococci

    * blood stream isolate

    ** active infection at death

    Conclusion:

    Viral, bacterial and fungal infections frequently complicated the post-SCT course of HLH patients. More data are needed to quantify infection risk for HLH patients relative to SCT for other indications and to determine whether infection prophylaxis and surveillance approaches may help improve HLH survival post-SCT.

    Zacharoula Oikonomopoulou, MD1, Charalampos Gousis, MD1, Roshni Patel, BA1, Sarah B. Klieger, MPH1, Adriana Kajon, PhD2, Alix Seif, MD, MPH3, Brian Fisher, DO, MPH, MSCE3 and Immunocompromised Pediatric Adenovirus Collaborative supported by HHSN2722011000040C, (1)Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Lovelace Respiratory Research Institute, Albuquerque, NM, (3)The Children's Hospital of Philadelphia, Philadelphia, PA

    Disclosures:

    Z. Oikonomopoulou, None

    C. Gousis, None

    R. Patel, None

    S. B. Klieger, None

    A. Kajon, None

    A. Seif, None

    B. Fisher, None

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