Infections and risk factors for infection-related mortality after pediatric allogeneic hematopoietic stem cell transplantation in Mexico: A single center retrospective study

• Published in: PloS one Vol. 18; no. 9; p. e0284628
• Main Authors: Elva Jiménez-Hernández, Juan Carlos Núñez-Enriquez, José Arellano-Galindo, María de Los Angeles Del Campo-Martínez, Perla Verónica Reynoso-Arenas, Alfonso Reyes-López, Alejandra Viridiana Delgado-Gaytan, María Del Socorro Méndez-Tovar, Teresa Marín-Palomares, María Teresa Dueñas-Gonzalez, Antonio Ortíz-Fernández, Inés Montero-Ponce, Laura Eugenia Espinosa-Hernández, Nora Nancy Núñez-Villegas, Ruy Pérez-Casillas, Berenice Sánchez-Jara, Angel García-Soto, Annecy Nelly Herver-Olivares, Ethel Zulie Jaimes-Reyes, Hector Manuel Tiznado-García, Octavio Martínez-Villegas, Betzayda Valdez-Garibay, Paloma Del Rocío Loza-Santiaguillo, Xochiketzalli García-Jiménez, Guadalupe Ortíz-Torres, Gabriela Jazmin Fernández-Castillo, Dulce María Aguilar-Olivares, Luis Alejandro Díaz-Padilla, Mario Alberto Noya-Rodríguez, Mariana García-Jiménez, Juan Manuel Mejía-Aranguré
• Format: Journal Article
• Language: English
• Published: Public Library of Science (PLoS) 01-01-2023
• ISSN: 1932-6203
• DOI: 10.1371/journal.pone.0284628

ObjectiveTo identify the type of infections and risk factors for infection-related mortality (IRM) after allogeneic hematopoietic stem cell transplantation (HSCT).MethodsRetrospective cohort study of patients <16 years of age treated in 2010-2019 was conducted. Unadjusted hazard ratios (HR) and adjusted hazard ratios (aHR) with 95% confidence intervals (95% CIs) were estimated using Cox regression. Cumulative incidence was calculated.ResultsData for 99 pediatric patients were analyzed. The myeloablative conditioning was the most used regimen (78.8%) and the hematopoietic stem cell source was predominantly peripheral blood (80.8%). Primary graft failure occurred in 19.2% of patients. Frequency of acute graft-versus-host disease was 46.5%. Total of 136 infectious events was recorded, the most common of which were bacterial (76.4%) followed by viral infection (15.5%) and then fungal infection (8.1%). The best predictors for infection subtypes where the following: a) for bacterial infection (the age groups of 10.1-15 years: aHR = 3.33; 95% CI: 1.62-6.85 and. >15 years: aHR = 3.34; 95% CI: 1.18-9.45); b) for viral infection (graft versus host disease: aHR = 5.36; 95% CI: 1.62-17.68), however, for fungal infection statistically significant predictors were not identified. Related mortality was 30% (n = 12). Increased risk for infection-related mortality was observed in patients with unrelated donor and umbilical cord stem cells recipients (HR = 3.12; 95% CI: 1.00-9.85).ConclusionsFrequencies of infections and infection-related mortality appear to be similar to those reported. Unrelated donors and stem cells from umbilical cord recipients were associated with a high risk of mortality.