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Features of Toxoplasma gondii reactivation after allogeneic hematopoietic stem-cell transplantation in a high seroprevalence setting

Bone Marrow Transplantation volume 55, pages 93–99 (2020)Cite this article

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Abstract

We performed a single-centre retrospective study to evaluate the effectiveness of Toxoplasma gondii prevention strategies after allogeneic stem-cell transplantation. The charts of 138 allogeneic stem-cell recipients over a 4-year period were reviewed. Forty-nine percent of patients were not receiving optimal trimethoprim–sulfamethoxazole (TMP–SMZ) prophylaxis at day +30, mainly due to persistent cytopenia. Six months after transplantation, the rate of toxoplasmosis reactivation was 11.6%, including nine cases of Toxoplasma infection and seven cases of Toxoplasma disease. Fifty-six percent of cases of reactivation occurred before day +30. Thirty-eight percent occurred in patients receiving atovaquone prophylaxis. In 57% of patients presenting with Toxoplasma disease, signs of disease were present at first evidence of Toxoplasma DNA in peripheral blood samples. This study illustrates the limitations inherent to currently used toxoplasmosis prevention strategies and argues for the use of a combined prophylactic and preemptive approach. After performing the initial study, we limited the use of atovaquone in favour of TMP–SMZ when possible, and implemented an early prevention strategy consisting of the introduction of prophylaxis starting on day of engraftment. Over the following 16 months, 88.9% of eligible Toxoplasma-seropositive patients were receiving TMP–SMZ at day +30, and the rate of early Toxoplasma reactivation was 1.5%.

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Authors and Affiliations

  1. AP-HP, Hôpital Saint-Antoine, Service d’Hématologie Clinique, F-75012, Paris, France

    Olivier Paccoud, Myriam Labopin, Florent Malard, Giorgia Battipaglia, Rémy Duléry, Mohamad Mohty & Eolia Brissot

  2. Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint-Antoine, F-75012, Paris, France

    Juliette Guitard & Christophe Hennequin

  3. Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012, Paris, France

    Myriam Labopin, Florent Malard, Mohamad Mohty & Eolia Brissot

  4. AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, F-75012, Paris, France

    Laure Surgers

  5. Sorbonne Université, INSERM U1135, Centre d’Immunologie et des Maladies Infectieuses (CIMI), Team E13, Paris, France

    Laure Surgers

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  1. Olivier Paccoud
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  2. Juliette Guitard
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Correspondence to Eolia Brissot.

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Paccoud, O., Guitard, J., Labopin, M. et al. Features of Toxoplasma gondii reactivation after allogeneic hematopoietic stem-cell transplantation in a high seroprevalence setting. Bone Marrow Transplant 55, 93–99 (2020). https://doi.org/10.1038/s41409-019-0641-y

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