Outcomes of hematopoietic cell transplantation (SCT) and combined immunosupression (IST) patients with severe aplastic anemia (SAA) admitted with life-threatening infections
Galina A. Novichkova, Mikhail A. Maschan, Lili A. Khachatrian, Dina D. Baidildina, Olga V. Goronkova, Galina G. Solopova, Elena V. Skorobogatova, Irina P. Shipitsina, Alexey A. Maschan
Federal Research Center for Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
Infections remain a dominant cause of treatment failure in children with AA. Often severe infections present at admission are considered as contraindications to curative therapy.
Among 164 pts admitted with AA between 1998–2005, 35 (21%) had serious infections. There were 23 males and 12 females (med age 10.6 y) with SAA (2 pts) or very SAA (33 pts). Twelve pts were affected by bacterial sepsis, 9 by invasive mycoses (invasive aspergillosis (IA) 7, candidiasis 2), 4 by mixed fungal and bacterial infections, 2 had pneumonia, 6 severe stomatitis, 3 sepsis of unknown origin and 1 had cellulitis. One pt died of Gram (-) septic shock – aged 24 hours – after admission, while in the other 34 pts either SCT (5 pts) or combined IST with ATG+Cyclosporine A (29 pts) were carried out. Med interval from admission was 28 d for SCT and 10 d for IST. Intensive appropriate antimicrobial therapy was given to all patients immediately after admission.
In all 5 SCT recipients complete resolution of infections (all IA) was achieved after bone marrow recovery. One pt died on day 176 from GVHD, CMV, and graft failure; the other 4 pts are alive. Of the 29 recipients of IST 14 (48%) are alive in complete (12 pts) or partial (2 pts) remission, whereas 15 died. Death occurred during the first, second, and third mo in 1, 2 and 1 pts respectively. In 8 nonresponders to IST the main cause of death was primary infection, whereas in 7 it resolved completely and they died from secondary infections or hemorrhages. As of 09/2008, 18 (51%) of the original 35 pts are alive: the OS rate is 51%±8% and failure-free survival is 31%±7%.
Intensive antimicrobial therapy allows the safe performing of SCT or IST in severely infected pts with SAA. Most of them survive the early post-treatment period, while half are long term survivors.
severe aplastic anemia, infections, hematopoietic cell transplantation, combined immunosupression