American Journal of Hematology / Allogeneic hematopoietic stem cell transplantation from unrelated donors is associated with higher infection rates in children with acute lymphoblastic leukemiaA prospective international multicenter trial on behalf of the BFMSG and the EBMTPDWP

Severe infections (SI) significantly impact on nonrelapse mortality after hematopoietic stem cell transplantation (HSCT). We assessed 432 children and adolescents with acute lymphoblastic leukemia (ALL) after total body irradiation based myeloablative HSCT within the multicenter ALLBFMSCT 2003 trial for SI grade 3 or higher according to common terminology criteria for adverse events. A total 172 patients experienced at least one SI. Transplantation from matched unrelated donors (MUD) was associated with any type of SI in the preengraftment period (hazard ratio [HR]: 2.57; P <.001), and with any SI between day +30 and+100 (HR: 2.91; P =.011). Bacterial (HR: 2.24; P =.041) and fungal infections (HR: 4.06; P =.057) occurred more often in the preengraftment phase and viral infections more often before day +30 (HR: 2.66; P =.007) or between day +30 and+100 (HR: 3.89; P =.002) after HSCT from MUD as compared to matched sibling donors. Chronic GvHD was an independent risk factor for any type of SI after day +100 (HR: 2.57; P <.002). We conclude that allogeneic HSCT from MUD in children and adolescents with pediatric ALL is associated with higher infection rates, which seems attributable to an intensified GvHD prophylaxis including serotherapy and methotrexate.(VLID)509852