High risk of invasive fungal disease in children undergoing hematopoietic cell transplantation or complex anticancer therapy: the adverse role of post-transplant CMV replication
| Autor: | Marlena Ewertowska, Agnieszka Jatczak-Gaca, Hanna Żołnowska, Anna Dąbrowska, Robert Dębski, Monika Łęcka, Barbara Tejza, Natalia Bartoszewicz, Anna Urbańczyk, Elżbieta Grześk, Andrzej Kołtan, Magdalena Dziedzic, Mariusz Wysocki, Agata Marjańska, Ewa Demidowicz, Sylwia Kołtan, Piotr Księżniakiewicz, Monika Pogorzała, Krzysztof Czyżewski, Joanna Cisek, Przemysław Gałązka, Jan Styczyński, Monika Richert-Przygońska |
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| Rok vydání: | 2021 |
| Předmět: |
inorganic chemicals
medicine.medical_specialty Acute leukemia Acute myeloblastic leukemia urogenital system business.industry Incidence (epidemiology) Hematology Malignancy medicine.disease Fungal pneumonia Gastroenterology Transplantation surgical procedures operative Oncology immune system diseases hemic and lymphatic diseases Internal medicine Epidemiology medicine Cumulative incidence business |
| Zdroj: | Acta Haematologica Polonica. 52:483-492 |
| ISSN: | 2300-7117 0001-5814 |
| DOI: | 10.5603/ahp.a2021.0025 |
| Popis: | Introduction: We analyzed the epidemiology and outcomes of treatment of invasive fungal disease (IFD) in children during anticancer therapy (PHO, pediatric hematology and oncology) or after hematopoietic cell transplantation (HCT) over a period of eight consecutive years in a single-center study. Material and methods: Overall, a total of 254 HCTs were performed, and 415 children were newly diagnosed for malignancy. Incidence, epidemiology and outcome of IFD were analyzed. Results: The cumulative incidence of any IFD was 32.6% in allo-HCT, 22.2% in PHO, and 6.0% in auto-HCT patients. The incidence of proven +probable IFD was 12.6%, 10.4%, and 6.0%, respectively. As many as 77.0% HCT and 67.4% PHO of fungal episodes occurred in acute leukemia patients: the highest incidence of any IFD was observed for acute lymphoblastic leukemia (29.3% in HCT; 40.5% in PHO) and for acute myeloblastic leukemia (51.1% in HCT; 65.0% in PHO) patients. There were no significant differences in the incidence of fungal infections in both allo-HCT and PHO patients between the 2-year periods. Factors contributing to an increased risk of IFD in allo-HCT patients were: CMV replication, and acute and chronic graft-versus-host disease (GvHD). Survival from IFD was 91.9% in PHO, and 78.1% in HCT patients. Fungal pneumonia in HCT patients resolved in 62.9%, while in PHO patients it resolved in 93.5%. Conclusions: The risk of IFD in allo-HCT patients is much higher than in auto-HSCT and PHO patients. The outcome of IFD is better in PHO and auto-HCT than in allo-HCT settings. |
| Databáze: | OpenAIRE |
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