Risks and outcomes of invasive fungal infections in pediatric patients undergoing allogeneic hematopoietic cell transplantation
Risks and outcomes of invasive fungal infections in pediatric patients undergoing allogeneic hematopoietic cell transplantation
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DOI：
10.1038/sj.bmt.1705113
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发表时间：
2005-10-01
影响因子：
4.8
通讯作者：
Agarwal, R
中科院分区：
文献类型：
--
作者：
Dvorak, CC;Steinbach, WJ;Agarwal, R
侵袭性真菌感染（IFI）是清髓性预处理后接受造血细胞移植（HCT）的成人患者感染性死亡的主要原因，但该问题在儿科人群中的程度尚不清楚。我们回顾性研究了在一个中心接受同种异体HCT的120例连续儿科患者中IFI的危险因素。在同种异体HCT后的第一年内，儿科患者中证实或可能的IFI发生率为13%，与成人患者中报告的发生率相当;然而，与成人患者中的IFI不同，儿童中的大多数IFI发生在移植后的第一个月内。IFI的主要危险因素是中性粒细胞减少持续时间、年龄大于10岁、因严重再生障碍性贫血或范可尼贫血而接受移植以及高剂量皮质类固醇给药10天或更长时间。与成人受者的既往报告相比，儿童HCT受者的IFI更有可能成功治疗（42%，5/12例患者）。在同种异体HCT后，非复发死亡率估计为17%（20/120例患者），其中35%（7例患者）直接归因于IFI。因此，IFI是接受同种异体HCT的儿童非复发死亡的重要原因，需要更有效的策略来预防和治疗IFI。
Invasive fungal infections (IFI) are the leading cause of infectious mortality in adult patients undergoing hematopoietic cell transplantation (HCT) after myeloablative conditioning, but the extent of this problem in the pediatric population is unclear. We retrospectively examined risk factors for IFI among 120 consecutive pediatric patients undergoing allogeneic HCT at a single center. The incidence of proven or probable IFI in pediatric patients during the first year after allogeneic HCT was 13%, comparable to the rate reported in adult patients; however, unlike IFI in adult patients, the majority of IFI in children occurred within the first month after transplantation. The primary risk factors for IFI were duration of neutropenia, age greater than 10 years, transplant for severe aplastic anemia or Fanconi anemia, and high-dose corticosteroid administration for 10 days or longer. IFI were more likely to be successfully treated (42%, 5/12 patients) in pediatric HCT recipients when compared to previous reports of adult recipients. Non-relapse mortality was estimated at 17% (20/120 patients) after allogeneic HCT, of which 35% ( seven patients) were directly attributed to IFI. Thus, IFI is a significant cause of nonrelapse mortality in children undergoing allogeneic HCT and more effective strategies are needed to prevent and treat IFI.