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Outcomes of toxoplasmosis after allogeneic hematopoietic stem cell transplantation and the role of antimicrobial prophylaxis

Bone Marrow Transplantation (2024)Cite this article

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Toxoplasma gondii is an opportunistic infection in allogeneic hematopoietic stem cell transplant (allo-HCT) recipients and could lead to life-threatening complications such as pneumonia, meningoencephalitis, or disseminated disease with mortality rate of up to 60% [1, 2]. Toxoplasmosis usually occurs secondary to reactivation of latent Toxoplasma infection rather than through new encounter [3, 4]. The risk factors of Toxoplasma reactivation include Toxoplasma-seropositive allo-HCT recipients, seronegative donors, conditioning regimens containing anti-thymocyte globulin and myeloablative chemotherapy, umbilical cord blood or unrelated donor grafts, graft-versus-host disease (GVHD), immunosuppressive treatment, and lack of Toxoplasma antimicrobial prophylaxis [5,6,7,8].

The incidence of Toxoplasma reactivation after allo-HCT ranges between 0.3% and 8% in North America to around 11.6% in endemic European countries [2, 5, 8,9,10]. Allo-HCT recipients can develop either Toxoplasma infection, an asymptomatic parasitemia defined by positive Toxoplasma PCR test in blood only (with or without fever); or Toxoplasma disease which is a constellation of clinical and radiological evidence of end-organ damage along with positive Toxoplasma PCR in blood or in other body fluids or positive histopathological examination [2, 6, 11]. In this study, we aimed to describe the real-world experience of monitoring Toxoplasma PCR in blood of Toxoplasma-seropositive patients following allo-HCT, and to evaluate the risk factors associated with Toxoplasma reactivation.

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Fig. 1: Study design and outcomes.

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Funding

This research work was supported in part by the Cancer Center Support Grant (NCI Grant P30 CA016672).

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Author notes

  1. These authors contributed equally: Alexandre E. Malek, Taha Al-Juhaishi.

  2. These authors jointly supervised this work: Victor E. Mulanovich, Sairah Ahmed.

Authors and Affiliations

  1. Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Alexandre E. Malek & Victor E. Mulanovich

  2. Department of Medicine- Division of Infectious Diseases, Louisiana State University Health Shreveport, Shreveport, LA, USA

    Alexandre E. Malek

  3. Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Taha Al-Juhaishi, Jeremy L. Ramdial, May Daher, Amanda L. Olson, Samer A. Srour, Gheath Alatrash, Betul Oran, Rohtesh S. Mehta, Issa F. Khouri, Qaiser Bashir, Nina Shah, Stefan O. Ciurea, Gabriela Rondon, Farzaneh Maadani, Chitra Hosing, David Marin, Partow Kebriaei, Katayoun Rezvani, Yago Nieto, Paolo Anderlini, Amin M. Alousi, Muhammad Salman Faisal, Muzaffar H. Qazilbash, Uday R. Popat, Richard E. Champlin, Elizabeth J. Shpall & Sairah Ahmed

  4. OU Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Department of Medicine—Section of Hematology and Medical Oncology, Oklahoma City, OK, USA

    Taha Al-Juhaishi

  5. Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Denái R. Milton

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Contributions

Conceptualization: AEM, TA, ES, VM, SA. Data gathering: AEM and TA. Formal analysis: DM. Writing of the original draft: AEM, TA, SA. Review and editing of the final draft: JR, MD, AO, SS, GA, BO, RM, IK, QB, NS, SC, GR, FM, CH, DM, PK, KR, YN, PA, AA, MF, MQ, UP, RC.

Corresponding author

Correspondence to Sairah Ahmed.

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Competing interests

SC declares Advisory board: Hansa Therapeutics, CareDx, Achrotech, Kiadis Pharma, Allogene, Celularity, MolMed, Phamacyclics; Research funds from Miltenyi Biotech, Kiadis Pharma. GR declares consulting agreement with Omeros Pharma. SA declares research support to institution for clinical trials from Seattle Genetics, Merck, Xencor, Chimagen and Tessa Therapeutics, has membership on Tessa Therapeutic’s and Chimagen scientific advisory committee, she serves on Data Safety Monitoring Board for Myeloid Therapeutics; she is a consultant for ADC therapeutics, KITE/Gilead.

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Malek, A.E., Al-Juhaishi, T., Milton, D.R. et al. Outcomes of toxoplasmosis after allogeneic hematopoietic stem cell transplantation and the role of antimicrobial prophylaxis. Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02238-x

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  • DOI: https://doi.org/10.1038/s41409-024-02238-x

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