title: Infectious complications following allogeneic stem cell transplantation by using anti-thymocyte globulin-based myeloablative conditioning regimens in children with hemoglobinopathies.
abstract: BACKGROUND
  Anti-thymocyte globulin (ATG) has been used to prevent graft failure/rejection in the setting of allogeneic stem cell transplantation (allo-SCT) for hemoglobinopathies; however, epidemiology data for transplant-related infections in this population are scarce.
  
  
  METHODS
  We retrospectively analyzed the epidemiology of bacterial, fungal, viral, and parasitic infections in a cohort of 105 children and adolescents with β-thalassemia (n = 100) or sickle cell disease (n = 5) who underwent allo-SCT using human leukocyte antigen (HLA)-identical sibling (n = 96) or HLA-compatible unrelated donors (n = 9) in a single institution. All patients received an ATG-based conditioning regimen.
  
  
  RESULTS
  The cumulative incidence of cytomegalovirus (CMV) viremia was 45.7% (95% confidence interval [CI] 33-55%), developing at a median of 48 (range 12-142) days without evidence of overt CMV disease. Herpes zoster developed in 8 patients at a median of 12 months post transplant, while 10 patients presented with late onset hemorrhagic cystitis at a median of 35 days post transplant. The cumulative incidence of bacteremia was 17.1% (95% CI 10.6-25%), occurring at a median of 74 (range 24-110) days. No patient developed probable or definite invasive fungal infection. Four deaths were recorded; 2 of them were attributed to infections (toxoplasmosis and Pneumocystis jirovecii pneumonia, respectively).
  
  
  CONCLUSIONS
  The rate of infections after allo-SCT, using an ATG-containing preparative regimen, in our population of pediatric patients with hemoglobinopathies is comparable to that reported elsewhere with the use of non-ATG containing regimens.
authors: Stem Cell Transplant Unit, Aghia Sophia Children's Hospital, Thivon and Papadiamantopoulou, Athens, Greece.
authors: E
authors: E
authors: Goussetis
authors: E
authors: E
authors: Efstathiou
authors: A
authors: A
authors: Paisiou
authors: G
authors: G
authors: Avgerinou
authors: K
authors: K
authors: Zisaki
authors: V J
authors: VJ
authors: Giamouris
authors: I
authors: I
authors: Peristeri
authors: V
authors: V
authors: Kitra
authors: G
authors: G
authors: Vessalas
authors: M N
authors: MN
authors: Gamaletsou
authors: N V
authors: NV
authors: Sipsas
authors: S
authors: S
authors: Graphakos
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000628:therapy*; D000961:Antilymphocyte Serum / Q000009:adverse effects*; D016470:Bacteremia / Q000209:etiology / Q000276:immunology; D002648:Child; D015331:Cohort Studies; D016572:Cyclosporine / Q000627:therapeutic use; D003556:Cystitis / Q000209:etiology / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000209:etiology / Q000276:immunology; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006562:Herpes Zoster / Q000209:etiology / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007239:Infections / Q000209:etiology* / Q000276:immunology; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000209:etiology / Q000276:immunology; D012189:Retrospective Studies; D014123:Toxoplasmosis / Q000209:etiology / Q000276:immunology; D019172:Transplantation Conditioning / Q000009:adverse effects*; D014766:Viremia / Q000209:etiology / Q000276:immunology; D017086:beta-Thalassemia / Q000628:therapy*
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016572:Cyclosporine
keywords: ATG; hemoglobinopathies; infections; stem cell transplantation