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.

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.

• Authors: O Zając-Spychała, J Wachowiak, K Czyżewski, M Dziedzic, M Wysocki, P Zalas-Więcek, A Szmydki-Baran, Ł Hutnik, M Matysiak, Z Małas, W Badowska, O Gryniewicz-Kwiatkowska, A Gietka, B Dembowska-Bagińska, K Semczuk, K Dzierżanowska-Fangrat, M Bartnik, T Ociepa, T Urasiński, J Frączkiewicz, M Salamonowicz, K Kałwak, E Gorczyńska, A Chybicka, N Irga-Jaworska, E Bień, E Drożyńska, L Chełmecka-Wiktorczyk, W Balwierz, I Zak, F Pierlejewski, W Młynarski, A Urbanek-Dądela, G Karolczyk, W Stolpa, G Sobol-Milejska, M Płonowski, M Krawczuk-Rybak, J Musiał, R Chaber, Z Gamrot-Pyka, M Woszczyk, R Tomaszewska, T Szczepański, J Kowalczyk, J Styczyński
• Journal: Transplant infectious disease : an official journal of the Transplantation Society (Transpl Infect Dis) Vol. 22 Issue 4 Pg. e13292 (Aug 2020) ISSN: 1399-3062 [Electronic] Denmark
• PMID: 32285579 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Topics

• Adolescent
• Bacterial Infections (epidemiology, mortality)
• Child
• Child, Preschool
• Disease-Free Survival
• Drug Resistance, Multiple, Bacterial
• Female
• Hematopoietic Stem Cell Transplantation
• Hodgkin Disease (complications, epidemiology)
• Humans
• Infant
• Invasive Fungal Infections (epidemiology, mortality)
• Lymphoma, Non-Hodgkin (complications, epidemiology)
• Male
• Retrospective Studies
• Risk Factors
• Virus Diseases (epidemiology, mortality)
• Young Adult