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Infectious complications in adult sickle cell anemia patients undergoing hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 56, pages 3078–3080 (2021)Cite this article

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Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an established curative option for sickle cell disease (SCD); with an overall survival (OS) of 90% when a matched related donor (MRD) is available [1,2]. Allo-HSCT can establish donor-derived erythropoiesis and may restore the function of some affected organs [3]. Since reversal of the sickle phenotype can be established with ~20% donor myeloid chimerism, non-myeloablative (NMA) conditioning regimens are increasingly being used as myeloablative (MA) conditioning regimens are associated with high treatment-related mortality in adults with SCD [4].

Despite the great success of allo-HSCT in curing many malignant and benign disorders, transplant-related infections remain a significant cause of morbidity and mortality. NMA allo-HSCT is associated with lower incidence of bacterial, fungal and viral infections compared to MA allo-HSCT [5]. Infectious complications in adult SCD patients undergoing allo-HSCT has not been described before. In this retrospective analysis, we evaluated the incidence of infectious complications in 91 consecutive SCD patients aged ≥14 years who underwent matched sibling donor (MSD) allo-HSCT with NMA conditioning at King Abdulaziz Medical City, Riyadh in the period of 2016–2019.

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References

  1. Howard J. Sickle cell disease: when and how to transfuse. Hematol Am Soc Hematol Educ Program. 2016;2016:625–31.

    Article  Google Scholar 

  2. Bhatia M, Sheth S. Hematopoietic stem cell transplantation in sickle cell disease: patient selection and special considerations. J Blood Med. 2015;6:229–38.

    PubMed  PubMed Central  Google Scholar 

  3. Walters MC, Hardy K, Edwards S, Adamkiewicz T, Barkovich J, Bernaudin F, et al. Pulmonary, gonadal, and central nervous system status after bone marrow transplantation for sickle cell disease. Biol Blood Marrow Transpl. 2010;16:263–72.

    Article  Google Scholar 

  4. Fitzhugh CD, Cordes S, Taylor T, Coles W, Roskom K, Link M, et al. At least 20% donor myeloid chimerism is necessary to reverse the sickle phenotype after allogeneic HSCT. Blood. 2017;130:1946–8.

    Article  CAS  Google Scholar 

  5. Busca A, Locatelli F, Barbui A, Ghisetti V, Cirillo D, Serra R, et al. Infectious complications following nonmyeloablative allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis. 2003;5:132–9.

    Article  CAS  Google Scholar 

  6. Alzahrani M, Damlaj M, Jeffries N, Alahmari B, Singh A, Rondelli D, et al. Non-myeloablative human leukocyte antigen-matched related donor transplantation in sickle cell disease: outcomes from three independent centres. Br J Haematol. 2021;192:761–8.

    Article  CAS  Google Scholar 

  7. Hsieh MM, Fitzhugh CD, Weitzel RP, Link ME, Coles WA, Zhao X, et al. Nonmyeloablative HLA-matched sibling allogeneic hematopoietic stem cell transplantation for severe sickle cell phenotype. JAMA 2014;312:48–56.

    Article  Google Scholar 

  8. Damlaj M, Khalid F, Alahmari B, Alaskar A, Ghazi S, Johani S, et al. Optimal pre-emptive cytomegalovirus therapy threshold in a patient population with high prevalence of seropositive status. Curr Res Transl Med. 2020;68:131–7.

    Article  Google Scholar 

  9. Liu J, Bian Z, Wang X, Xu LP, Fu Q, Wang C, et al. Inverse correlation of Vdelta2(+) T-cell recovery with EBV reactivation after haematopoietic stem cell transplantation. Br J Haematol. 2018;180:276–85.

    Article  CAS  Google Scholar 

  10. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46:1813–21.

    Article  Google Scholar 

  11. Brown RA, Herzig RH, Wolff SN, Frei-Lahr D, Pineiro L, Bolwell BJ, et al. High-dose etoposide and cyclophosphamide without bone marrow transplantation for resistant hematologic malignancy. Blood. 1990;76:473–9.

    Article  CAS  Google Scholar 

  12. Kamboj M, Son C, Cantu S, Chemaly RF, Dickman J, Dubberke E, et al. Hospital-onset Clostridium difficile infection rates in persons with cancer or hematopoietic stem cell transplant: a C3IC network report. Infect Control Hosp Epidemiol. 2012;33:1162–5.

    Article  Google Scholar 

  13. Martin SI, Marty FM, Fiumara K, Treon SP, Gribben JG, Baden LR. Infectious complications associated with alemtuzumab use for lymphoproliferative disorders. Clin Infect Dis. 2006;43:16–24.

    Article  CAS  Google Scholar 

  14. Kanda Y, Oshima K, Kako S, Fukuda T, Uchida N, Miyamura K, et al. In vivo T-cell depletion with alemtuzumab in allogeneic hematopoietic stem cell transplantation: Combined results of two studies on aplastic anemia and HLA-mismatched haploidentical transplantation. Am J Hematol. 2013;88:294–300.

    Article  CAS  Google Scholar 

  15. Chakrabarti S, Mackinnon S, Chopra R, Kottaridis PD, Peggs K, O’Gorman P, et al. High incidence of cytomegalovirus infection after nonmyeloablative stem cell transplantation: potential role of Campath-1H in delaying immune reconstitution. Blood. 2002;99:4357–63.

    Article  CAS  Google Scholar 

  16. Rebello P, Cwynarski K, Varughese M, Eades A, Apperley JF, Hale G. Pharmacokinetics of CAMPATH-1H in BMT patients. Cytotherapy, 2001;3:261–7.

    Article  CAS  Google Scholar 

  17. Bhatt ST, Bednarski JJ, Berg J, Trinkaus K, Murray L, Hayashi R, et al. Immune reconstitution and infection patterns after early alemtuzumab and reduced intensity transplantation for nonmalignant disorders in pediatric patients. Biol Blood Marrow Transpl. 2019;25:556–61.

    Article  CAS  Google Scholar 

  18. King AA, Kamani N, Bunin N, Sahdev I, Brochstein J, Hayashi RJ, et al. Successful matched sibling donor marrow transplantation following reduced intensity conditioning in children with hemoglobinopathies. Am J Hematol. 2015;90:1093–8.

    Article  CAS  Google Scholar 

  19. Park SH, Choi SM, Lee DG, Choi JH, Yoo JH, Kim SH, et al. Infectious complications associated with alemtuzumab use for allogeneic hematopoietic stem cell transplantation: comparison with anti-thymocyte globulin. Transpl Infect Dis. 2009;11:413–23.

    Article  CAS  Google Scholar 

  20. Fisher A, Seguel JM, de la Torre AN, Wilson D, Merchant A, Arora RK, et al. Effect of sirolimus on infection incidence in liver transplant recipients. Liver Transpl. 2004;10:193–8.

    Article  Google Scholar 

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Authors and Affiliations

  1. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

    Khadega A. Abuelgasim, Moussab Damlaj, Bader Alahmari, Ayman Alhejazi, Ahmed Alaskar & Mohsen Alzahrani

  2. Oncology Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia

    Khadega A. Abuelgasim, Moussab Damlaj, Reem M. Ramli, Bader Alahmari, Ayman Alhejazi, Ahmed Alaskar & Mohsen Alzahrani

  3. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Khadega A. Abuelgasim, Moussab Damlaj, Sumayyah Altamimi, Bader Alahmari, Ayman Alhejazi, Ahmed Alaskar & Mohsen Alzahrani

  4. Infectious Diseases Division, Internal Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia

    Mohammad Bosaeed, Hind Abdullah & Rahma Alzahrani

  5. Internal Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia

    Nourah Alzughaibi

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  1. Khadega A. Abuelgasim
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  2. Moussab Damlaj
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  11. Ahmed Alaskar
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  12. Mohsen Alzahrani
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Contributions

KAA: Conceptualization, Methodology, Data acquisition, Writing—Original draft preparation. MD: Conceptualization, Formal analysis, Writing—Reviewing and editing. MB: Conceptualization, Methodology, Writing—Reviewing and editing. SA, HA, RMR, RA, and NA: Conceptualization, Data acquisition, Writing-Reviewing and editing. BA, AA, AA, MA: Writing—Reviewing and editing.

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Correspondence to Khadega A. Abuelgasim.

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Abuelgasim, K.A., Damlaj, M., Bosaeed, M. et al. Infectious complications in adult sickle cell anemia patients undergoing hematopoietic stem cell transplantation. Bone Marrow Transplant 56, 3078–3080 (2021). https://doi.org/10.1038/s41409-021-01457-w

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