Abstract
Infectious complications constitute a major cause of morbidity and mortality in pediatric and adult patients undergoing hematopoietic SCT (HSCT). Current guidelines and recommendations for prevention of infections in children after HSCT are presented in this mini review. The paper is based on evidence-based recommendations rated by the strength of the recommendation and the quality of the supporting evidence. Prophylaxis strategy based on risk stratification includes: (1) general infection control in hospital environment, (2) pharmacological approach related to antibacterial, antifungal and antiviral agents and (3) vaccination. Although most studies were carried out on adults only, some included both pediatric and adult patients. No differences in prophylaxis strategy and efficacy among age groups are reported. With changing practices, transplant teams are encouraged to review local patterns of prophylaxis strategy.
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References
Centers for Disease Control and Prevention; Infectious Disease Society of America; American Society of Blood and Marrow Transplantation. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. MMWR Recomm Rep 2000; 49: 1–125.
O'Brien SN, Blijlevens NM, Mahfouz TH, Anaissie EJ . Infections in patients with hematological cancer: recent developments. Hematology Am Soc Hematol Educ Program 2003; 438–472.
Brown JMY . Fungal infections after hematopoietic cell transplantation. In: Blume KG, Forman SJ, Appelbaum FR (eds). Thomas' Hematopoietic Cell Transplantation. Blackwell Publishing: Malden, 2004, pp 683–700.
Strasfeld L, Weinstock DM . Antifungal prophylaxis among allogeneic hematopoietic stem cell transplant recipients: current issues and new agents. Expert Rev Anti Infect Ther 2006; 4: 457–468.
Nucci M, Andrade F, Vigorito A, Trabasso P, Aranha JF, Maiolino A et al. Infectious complications in patients randomized to receive allogeneic bone marrow or peripheral blood transplantation. Transpl Infect Dis 2003; 5: 167–173.
Dykewicz CA . Hospital infection control in hematopoietic stem cell transplant recipients. Emerg Infect Dis 2001; 7: 263–267.
Dykewicz CA . Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients: focus on community respiratory virus infections. Biol Blood Marrow Transplant 2001; 7 (Supp l): 19S–22S.
Dykewicz CA . Summary of the guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Clin Infect Dis 2001; 33: 139–144.
van de Wetering MD, de Witte MA, Kremer LC, Offringa M, Scholten RJ, Caron HN . Efficacy of oral prophylactic antibiotics in neutropenic afebrile oncology patients: a systematic review of randomised controlled trials. Eur J Cancer 2005; 41: 1372–1382.
Bucaneve G, Castagnola E, Viscoli C, Leibovici L, Menichetti F . Quinolone prophylaxis for bacterial infections in afebrile high-risk neutropenic patients. EJC Supplements 2007; 2: 5–12.
Maltezou HC, Petropoulos D, Choroszy M, Gardner M, Mantzouranis EC, Rolston KV et al. Dapsone for Pneumocystis carinii prophylaxis in children undergoing bone marrow transplantation. Bone Marrow Transplant 1997; 20: 879–881.
Goodman JL, Winston DJ, Greenfield RA, Chandrasekar PH, Fox B, Kaizer H et al. A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. N Engl J Med 1992; 326: 845–851.
Marr KA, Seidel K, Slavin MA, Bowden RA, Schoch HG, Flowers ME et al. Prolonged fluconazole prophylaxis is associated with persistent protection against candidiasis-related death in allogeneic marrow transplant recipients: long-term follow-up of a randomized, placebo-controlled trial. Blood 2000; 96: 2055–2061.
Wingard JR, Carter SL, Walsh TJ, Kurtzberg J, Small TN, Gersten ID et al. Results of a randomized, double-blind trial of fluconazole (FLU) vs. voriconazole (VORI) for the prevention of invasive fungal infections (IFI) in 600 allogeneic blood and marrow transplant (BMT) patients. Blood 2007; 110: 163 (abstract).
Ljungman P, Reusser P, de la Camara R, Einsele H, Engelhard D, Ribaud P et al. Management of CMV infections: recommendations from the infectious diseases working party of the EBMT. Bone Marrow Transplant 2004; 33: 1075–1081.
Slavin MA, Meyers JD, Remington JS, Hackman RC . Toxoplasma gondii infection in marrow transplant recipients: a 20-year experience. Bone Marrow Transplant 1994; 13: 549–557.
Grady R . Safety profile of quinolone antibiotics in the pediatric population. Pediatr Infect Dis J 2003; 22: 1128–1132.
Castagnola E, Boni L, Giacchino M, Cesaro S, De Sio L, Garaventa A et al. A multicenter, randomized, double blind placebo-controlled trial of amoxicillin–clavulanate for the prophylaxis of fever and infection in neutropenic children with cancer. Pediatr Infect Dis J 2003; 22: 359–365.
Castagnola E, Bagnasco F, Faraci M, Caviglia I, Caruso S, Cappelli B et al. Incidence of bacteremias and invasive mycoses in children undergoing allogeneic hematopoietic stem cell transplantation: a single center experience. Bone Marrow Transplant 2008; 41: 339–347.
Prentice HG, Kibbler CC, Prentice AG . Towards a targeted, risk-based, antifungal strategy in neutropenic patients. Br J Haematol 2000; 110: 273–284.
Ullmann AJ, Lipton JH, Vesole DH, Chandrasekar P, Langston A, Tarantolo SR et al. Posaconazole or fluconazole for prophylaxis in severe graft-versus-host disease. N Engl J Med 2007; 356: 335–347.
Slavin MA, Osborne B, Adams R, Levenstein MJ, Schoch HG, Feldman AR et al. Efficacy and safety of fluconazole prophylaxis for fungal infections after marrow transplantation—a prospective, randomized, double-blind study. J Infect Dis 1995; 171: 1545–1552.
Castagnola E, Cappelli B, Erba D, Rabagliati A, Lanino E, Dini G . Cytomegalovirus infection after bone marrow transplantation in children. Hum Immunol 2004; 65: 416–422.
Winston DJ, Baden LR, Gabriel DA, Emmanouilides C, Shaw LM, Lange WR et al. Pharmacokinetics of ganciclovir after oral valganciclovir versus intravenous ganciclovir in allogeneic stem cell transplant patients with graft-versus-host disease of the gastrointestinal tract. Biol Blood Marrow Transplant 2006; 12: 635–640.
Einsele H, Reusser P, Bornhauser M, Kalhs P, Ehninger G, Hebart H et al. Oral valganciclovir leads to higher exposure to ganciclovir than intravenous ganciclovir in patients following allogeneic stem cell transplantation. Blood 2006; 107: 3002–3008.
Erard V, Guthrie KA, Varley C, Heugel J, Wald A, Flowers ME et al. One-year acyclovir prophylaxis for preventing varicella-zoster virus disease after hematopoietic cell transplantation: no evidence of rebound varicella-zoster virus disease after drug discontinuation. Blood 2007; 110: 3071–3077.
Ljungman P, Engelhard D, de la Camara R, Einsele H, Locasciulli A, Martino R et al. Vaccination of stem cell transplant recipients: recommendations of the Infectious Diseases Working Party of the EBMT. Bone Marrow Transplant 2005; 35: 737–746.
Machado CM . Reimmunization after bone marrow transplantation---current recommendations and perspectives. Braz J Med Biol Res 2004; 37: 151–158.
Meisel R, Kuypers L, Dirksen U, Schubert R, Gruhn B, Strauss G et al. Pneumococcal conjugate vaccine provides early protective antibody responses in children after related and unrelated allogeneic hematopoietic stem cell transplantation. Blood 2007; 109: 2322–2326.
Cordonnier C, Labopin M, Chesnel V, Ribaud P, De la Camara R, Martino R et al. Inluence of immunisation timing on the response to conjugate-pneumococcal vaccine after allogeneic stem cell transplant: final results of the EBMT IDWP01 Trial. Bone Marrow Transplant 2008; 41 (Suppl 1): S2 (abstract O102).
Ilan Y, Nagler A, Adler R, Tur-Kaspa R, Slavin S, Shouval D . Ablation of persistent hepatitis B by bone marrow transplantation from a hepatitis B-immune donor. Gastroenterology 1993; 104: 1818–1821.
Wimperis JZ, Brenner MK, Prentice HG, Reittie JE, Karayiannis P, Griffiths PD et al. Transfer of a functioning humoral immune system in transplantation of T-lymphocyte-depleted bone marrow. Lancet 1986; 1: 339–343.
Molrine DC . Recommendations for immunizations in stem cell transplantation. Pediatr Transplant 2003; 7 (Suppl 3): 76–85.
Molrine DC, Guinan EC, Antin JH, Parsons SK, Weinstein HJ, Wheeler C et al. Donor immunization with Haemophilus influenzae type B (HIB)-conjugate vaccine in allogeneic bone marrow transplantation. Blood 1996; 87: 3012–3018.
Molrine DC, Antin JH, Guinan EC, Soiffer RJ, MacDonald K, Malley R et al. Donor immunization with pneumococcal conjugate vaccine and early protective antibody responses following allogeneic hematopoietic cell transplantation. Blood 2003; 101: 831–836.
Storek J, Dawson MA, Lim LC, Burman BE, Stevens-Ayers T, Viganego F et al. Efficacy of donor vaccination before hematopoietic cell transplantation and recipient vaccination both before and early after transplantation. Bone Marrow Transplant 2004; 33: 337–346.
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Styczynski, J., Gil, L. & on behalf of the EBMT Paediatric Diseases Working Party. Prevention of infectious complications in pediatric HSCT. Bone Marrow Transplant 42 (Suppl 2), S77–S81 (2008). https://doi.org/10.1038/bmt.2008.289
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DOI: https://doi.org/10.1038/bmt.2008.289
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