Bloodstream Infection after Stem Cell Transplantation in Children with Idiopathic Aplastic Anemia.
Bloodstream Infection after Stem Cell Transplantation in Children with Idiopathic Aplastic Anemia.
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特发性再生障碍性贫血儿童干细胞移植后的血流感染。
DOI：
10.1016/j.bbmt.2014.04.006
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Kojima S
中科院分区：
文献类型：
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作者：
Kobayashi R;Yabe H;Kikuchi A;Kudo K;Yoshida N;Watanabe K;Muramatsu H;Takahashi Y;Inoue M;Koh K;Inagaki J;Okamoto Y;Sakamaki H;Kawa K;Kato K;Suzuki R;Kojima S
血流感染(BSI)是造血干细胞移植(HSCT)最常见的感染性并发症，可导致相当大的发病率和死亡率。确定BSI的危险因素可能有助于减少与移植相关的死亡。本研究分析了再生障碍性贫血(AA)患儿HSCT后BSI的发生率及其危险因素。351例再生障碍性贫血患者中有39例发生BSI(11.1%)。BSI的发病时间中位数为移植后8天(0至92天)。BSI患者的5年总生存率低于非BSI患者(63.32%±7.90%vs93.35%±1.44%；P<；0.0001)。单因素分析确定以下变量与BSI有关：抗胸腺细胞球蛋白(ATG)免疫抑制治疗史、来自无关供者的移植、移植前频繁输血、重大或重大+轻微ABO类型不匹配、使用他克莫司和不使用环孢菌素预防移植物抗宿主病，以及从诊断到移植的较长时间。在这些因素中，经多因素分析，从诊断到移植的较长时间是唯一具有统计学意义的BSI危险因素。在接受亲属供者造血干细胞移植的患者中，移植时年龄14岁的≥是发生骨髓抑制的危险因素。相反，ATG免疫抑制治疗史、HSCT前频繁输血、移植物失败、大或大+小ABO血型不匹配是非亲属供者进行HSCT患者发生BSI的危险因素。因为没有BSI的5年总存活率为90%，即使在接受了非血缘关系供者移植的患者中，控制BSI对于AA儿童HSCT的成功也是非常重要的。
Bloodstream infection (BSI) is the most common infectious complication of hematopoietic stem cell transplantation (HSCT) and can cause substantial morbidity and mortality. Identification of risk factors for BSI might be helpful in efforts to reduce transplantation-related death. This study analyzed the incidence of BSI and risk factors for BSI after HSCT in pediatric patients with aplastic anemia (AA). BSI occurred in 39 of the 351 patients with AA (11.1%). Onset of BSI occurred at a median of 8 days after HSCT (range, 0 to 92 days). The 5-year overall survival rate was lower in patients with BSI than in patients without BSI (63.32% ± 7.90% versus 93.35% ± 1.44%;P< .0001). Univariate analysis identified the following variables as associated with BSI: history of immunosuppressive therapy with antithymocyte globulin (ATG), transplantation from an unrelated donor, frequent blood transfusion before transplantation, major or major plus minor ABO type mismatch, graft-versus-host disease prophylaxis with tacrolimus and without cyclosporine, and long interval from diagnosis to transplantation. Among these factors, long interval from diagnosis to transplantation was the sole statistically significant risk factor for BSI on multivariate analysis. In patients who underwent HSCT from a related donor, age ≥14 years at transplantation was risk factor for BSI. In contrast, history of immunosuppressive therapy with ATG, frequent blood transfusion before HSCT, graft failure, and major or major plus minor ABO type mismatch were risk factors for BSI in patients who underwent HSCT from an unrelated donor. Because the overall 5-year survival rate without BSI was >90%, even in patients who were received a transplant from an unrelated donor, control of BSI is very important for successful HSCT in pediatric patients with AA.