Program Schedule

439
Infection Risk in Pediatric Stem Cell Transplant Recipients for Hemophagocytic Lymphohistiocytosis Versus Acute Leukemia

Session: Poster Abstract Session: Transplant Infectious Diseases
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Background:

Allogeneic hematopoietic stem cell transplantation (SCT) is often used as definitive therapy for hemophagocytic lymphohistiocytosis (HLH). Data on infectious complications in post-SCT HLH patients are limited, with no analyses comparing their infectious risk to other SCT recipients. This study compares post-SCT infection frequency and mortality rates between pediatric HLH and leukemia patients.

Methods:

All HLH SCT patients from 1997 to 2009 were identified from the bone marrow registry at The Children's Hospital of Philadelphia. HLH patients were matched one-to-one to leukemia SCT patients by age and transplant year. Data on demographics, donor source, conditioning regimens, microbiologically-proven infections, and vital status 6 months post-SCT were collected. Multivariate conditional Poisson and logistic/Cox regression models compared infection rate per follow-up days and mortality, respectively.

Results:

Eighteen HLH SCT patients (100%) had at least one infection, (median: 2; IQR: 1 to 4). Half of the leukemia SCT recipients had at least 1 infection (median: 1; IQR: 0 to 2). Compared to leukemia patients, HLH patients had a greater incidence of total infections (IRR: 2.47, 95% CI: 1.01 to 6.05; Table 1). After adjusting for sex, conditioning regimen, and antithymocyte or antilymphocyte globulin (ATG/ALG) use, this difference was no longer significant (IRR:  1.69, 95% CI: 0.72 to 3.95). Receipt of ATG/ALG was independently associated with a greater infection rate (IRR: 2.30, 95% CI: 1.10 to 4.81). Mortality rate (HLH 22%, leukemia 28%) and time to death post-SCT did not differ between groups.

Conclusion:

HLH SCT recipients have a higher infection rate in the 6 months post-HSCT compared to leukemia patients, a factor associated with pre-transplant ATG/ALG use. It is possible a difference in mortality and infection rates exists beyond the variation in ATG/ALG exposure.  Further study of larger cohorts is needed.

 

Table 1. Microbiologically Proven Infection

 

HLH

Leukemia

 

 n (%)

Bacteremia

 

 

Gram Positive

14 (42)

5 (35)

Gram Negative

2 (6)

6 (42)

Candidemia

2 (6)

0

Viral

 

 

Respiratory

9 (27)

2 (14)

Reactivation

6 (18)

1 (7)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lisa Pedevillano, MBS1, Sarah Klieger, MPH2, Alix E. Seif, MD, MPH3, Richard L. Hodinka, MD, PhD4, Adriana E. Kajon5, Kim E. Nichols, MD6, Nancy Bunnin, MD6, Rui Xiao, PhD7, Zacharoula Oikonomopoulou, MD1, Charalampos Gousis, MD8 and Brian T. Fisher, DO, MSCE9, (1)Division of Infectious Diseases, The Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, (2)Division of Infectious Disease, The Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, (3)Division of Oncology and Department of, The Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, (4)Division of Infectious Diseases, Departments of Pediatrics, Pathology and Clinical Virology, The Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, (5)Infectious Disease Program, Lovelace Respiratory Research Institute, Alburquerque, NM, (6)Division of Oncology, Department of Pediatrics, The Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, (7)Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, (8)Division of Infectious Diseases, The Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Phildelphia, PA, (9)Division of Infectious Diseases, Department of Pediatrics, Center for Pediatric Clinical Effectiveness, Center for Clinical Epidemiology and Biostatistics, The Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Disclosures:

L. Pedevillano, None

S. Klieger, None

A. E. Seif, None

R. L. Hodinka, None

A. E. Kajon, None

K. E. Nichols, None

N. Bunnin, None

R. Xiao, None

Z. Oikonomopoulou, None

C. Gousis, None

B. T. Fisher, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

Sponsoring Societies:

© 2014, idweek.org. All Rights Reserved.

Follow IDWeek