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Multicenter Study
. 2020 Aug;22(4):e13292.
doi: 10.1111/tid.13292. Epub 2020 Apr 23.

Hematopoietic stem cell transplantation does not increase the risk of infection-related complications for pediatric patients with Hodgkin and non-Hodgkin lymphomas: A multicenter nationwide study

O Zając-Spychała  1 , J Wachowiak  1 , K Czyżewski  2 , M Dziedzic  2 , M Wysocki  2 , P Zalas-Więcek  3 , A Szmydki-Baran  4 , Ł Hutnik  4 , M Matysiak  4 , Z Małas  5 , W Badowska  5 , O Gryniewicz-Kwiatkowska  6 , A Gietka  6 , B Dembowska-Bagińska  6 , K Semczuk  7 , K Dzierżanowska-Fangrat  7 , M Bartnik  8 , T Ociepa  8 , T Urasiński  8 , J Frączkiewicz  9 , M Salamonowicz  9 , K Kałwak  9 , E Gorczyńska  9 , A Chybicka  9 , N Irga-Jaworska  10 , E Bień  10 , E Drożyńska  10 , L Chełmecka-Wiktorczyk  11 , W Balwierz  11 , I Zak  12 , F Pierlejewski  13 , W Młynarski  13 , A Urbanek-Dądela  14 , G Karolczyk  14 , W Stolpa  15 , G Sobol-Milejska  15 , M Płonowski  16 , M Krawczuk-Rybak  16 , J Musiał  17 , R Chaber  17 , Z Gamrot-Pyka  18 , M Woszczyk  18 , R Tomaszewska  19 , T Szczepański  19 , J Kowalczyk  20 , J Styczyński  2
Affiliations
Multicenter Study

Hematopoietic stem cell transplantation does not increase the risk of infection-related complications for pediatric patients with Hodgkin and non-Hodgkin lymphomas: A multicenter nationwide study

O Zając-Spychała et al. Transpl Infect Dis. 2020 Aug.

Abstract

Background: Hodgkin (HL) and non-Hodgkin lymphoma (NHL) represent a spectrum of lymphoid malignancies that are often curable with currently applied treatment regimens; however, 15%-30% of lymphoma patients still suffer from relapsed or refractory (rel/ref) disease. Although hematopoietic stem cell transplantation (HSCT) improves outcomes of second-line therapy for lymphoma in childhood, the complication rates in this group of patients, especially infectious complications (IC), remain unclear.

Objective: The aim of this population-based cohort study was a retrospective analysis of incidence, epidemiology and profile of bacterial infections (BI), invasive fungal disease (IFD), and viral infections (VI) in primary or rel/ref lymphoma patients, both HL and NHL.

Patients and methods: We subdivided lymphoma patients into three groups: patients with primary conventional chemotherapy/radiotherapy regimens (group A), patients with rel/ref lymphoma treated with second-line chemotherapy (group B), and rel/ref lymphoma patients who underwent HSCT (group C). The medical records of the patients were biannually reported by each pediatric oncology center, and the data were analyzed centrally.

Results: Within 637 patients with primary lymphoma, at least one IC was diagnosed in 255 (40.0%), among 52 patients with rel/ref lymphoma 24 (46.2%) ICs were observed, and in transplanted group, 28 (57.1%) out of 49 children were diagnosed with IC (P = .151). The distribution of etiology of IC differed between the patient groups (A, B, C), with a predominance of BI in group A (85.6% vs 72.0% and 47.9%, respectively), VI in group C (9% and 16.0% vs 46.6%, respectively), and IFD in group B (5.4% vs 12.0% vs 5.5%, respectively). Overall, 500 (68.0%) episodes of bacterial IC were diagnosed in the entire group. Apart from HL patients treated with chemotherapy, in all the other subgroups of patients Gram-positives were predominant. The rate of multidrug-resistant bacteria was high, especially for Gram-negatives (41.1% in group A, 62.5% in group B, and 84.6% in group C). The infection-related mortality was comparable for each group.

Conclusions: The incidence of IC was comparable during first- and second-line chemotherapy and after HSCT, but their profile was different for primary or re/ref lymphoma and depended on the type of therapy.

Keywords: children; epidemiology; hematopoietic stem cell transplantation; infection; lymphoma; multidrug resistance.

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References

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