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Carlesse F, Paixão de Sousa da Silva AM, Sztajnbok J, Litivinov N, Peron K, Otsuka M, Volpe Arnoni M, Schirmer M, de Oliveira Costa P, Munhoz Cavalcanti de Albuquerque AL, Morales H, Lopez-Medina E, A. Portilla C, Valenzuela R, Motta F, Motta FA, de Almeida Junior JN, Santolaya ME, Lopes Colombo A. Landscape of Invasive Fusariosis in Pediatric Cancer Patients: Results of a Multicenter Observational Study From Latin America. Open Forum Infect Dis 2024; 11:ofae285. [PMID: 38872851 PMCID: PMC11170500 DOI: 10.1093/ofid/ofae285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
Invasive fusariosis (IF) is a life-threatening opportunistic infection that affects vulnerable hosts. We conducted a multicenter and multinational retrospective study to characterize the natural history and clinical management of IF in pediatric cancer patients. We selected patients <18 years old who were sequentially hospitalized in 10 Latin American medical centers with a diagnosis of IF between 2002 and 2021. Data were collected using an electronic case report form complemented by a dictionary of terms. We assessed mortality rates at 30, 60, and 90 days. We collected data from 60 episodes of IF (median age, 9.8 years) that were mostly documented in patients with hematologic cancer (70%). Other risk conditions found were lymphopenia (80%), neutropenia (76.7%), and corticosteroid exposure (63.3%). IF was disseminated in 55.6% of patients. Skin lesions was present in 58.3% of our patients, followed by pulmonary involvement in 55%, sinusitis in 21.7%, bone/joint involvement in 6.7% and 1 case each of endocarditis and brain abscess. Positive blood and skin biopsy cultures were detected in 60% and 48.3% of cases, respectively. Fusarium solani complex was the most commonly identified agent (66.6%). The majority of patients received monotherapy within the first 72 hours (71.6%), either with voriconazole or amphotericin B formulation. The mortality rates at 30, 60, and 90 days were 35%, 41.6%, and 45%, respectively. An important factor affecting mortality rates appears to be disseminated disease. The high percentage of patients with fungal involvement in multiple organs and systems highlights the need for extensive workup for additional sites of infection in severely immunocompromised children.
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Affiliation(s)
- Fabianne Carlesse
- Instituto de Oncologia Pediátrica—IOP-GRAACC-UNIFESP, Departamento de Pediatria, São Paulo, Brazil
- Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Jaques Sztajnbok
- Instituto de Tratamento do Cancer Infantil (ITACI), Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Instituto de Infectologia Emilio Ribas, Intensive Care Unit, Department of Emergency Medical Care, São Paulo, Brazil
| | - Nadia Litivinov
- Instituto de Tratamento do Cancer Infantil (ITACI), Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Karina Peron
- Instituto de Tratamento do Cancer Infantil (ITACI), Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Marcelo Schirmer
- Instituto Nacional do Cancer—INCA, Department of Pediatrics, Rio de Janeiro, Brazil
| | | | | | - Hugo Morales
- Hospital Erasto Gaertner, Department of Pediatrics, Curitiba, Brazil
| | - Eduardo Lopez-Medina
- Centro de Estudios en Infectología Pediátrica CEIP, Department of Pediatrics, Universidad del Valle, Clínica Imbanaco, Grupo Quironsalud, Cali, Colombia
| | - Carlos A. Portilla
- Centro de Estudios en Infectología Pediátrica CEIP, Department of Pediatrics, Universidad del Valle, Clínica Imbanaco, Grupo Quironsalud, Cali, Colombia
| | - Romina Valenzuela
- Faculty of Medicine, Hospital Dr Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
| | - Fabrizio Motta
- Santa Casa de Misericórdia de Porto Alegre, Department of Pediatrics, Porto Alegre, Brazil
| | | | - João Nobrega de Almeida Junior
- Departamento de Medicina- Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
- Antimicrobial Resistance Institute of São Paulo (ARIES), Departamento de Medicina, UNIFESP, São Paulo, Brazil
| | - Maria Elena Santolaya
- Faculty of Medicine, Hospital Dr Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
| | - Arnaldo Lopes Colombo
- Departamento de Medicina- Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
- Antimicrobial Resistance Institute of São Paulo (ARIES), Departamento de Medicina, UNIFESP, São Paulo, Brazil
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Arslantaş E, Şanlı K, Acar SO, Tekgündüz SA, Ayçiçek A. Granulocyte transfusions in life-threatening infections of children with hemato-oncological diseases. Transfus Apher Sci 2024; 63:103897. [PMID: 38395673 DOI: 10.1016/j.transci.2024.103897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
Granulocytes are the most important cells for host defense during infections. Granulocyte suspension transfusions (GTx) may be given as additional treatment in severely neutropenic patients with life-threatening infections when antimicrobial therapy is inadequate. The aim of this study was to evaluate the effectiveness and safety of GTx for the treatment of children with hemato-oncological disease, febrile neutropenia and serious life-threatening infections. Patients who underwent GTx between July 2020 and September 2022 were evaluated retrospectively. Hematologic and clinical response rates, adverse effects, characteristics of infection episodes and survival data of the patients were analyzed. During the study period, 60 patients received a total of 313 GTx for 81 infection episodes with a median number of GTx/infection episode of 3 (range 1-29). The median neutrophil count per bag was 20.8 (range 7.9-68.3) × 109 and the median neutrophil count per kg body weight was 0.82 (range 0.17-9.2) × 109. Clinical response was 85 %. Clinical response decreased significantly as the duration of neutropenia increased (p = 0.002). Hematologic response was calculated in 198 GTx (GTx given with pre-transfusion neutrophil count ≤ 0.5 × 109/L); hematologic response rate was 34 %. The infection-related mortality was 15 % and overall survival rate was 87 % and 70 % on days 30 and 90, respectively. No serious side effects were observed in any patient. Granulocyte transfusions appear to be safe and effective supportive treatment in neutropenic children with hematologic/oncologic diseases and severe infections.
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Affiliation(s)
- Esra Arslantaş
- Department of Pediatric Hematology and Oncology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Kamuran Şanlı
- Department of Clinical Microbiology, Head of Blood Center, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Sultan Okur Acar
- Department of Pediatric Hematology and Oncology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Sibel Akpınar Tekgündüz
- Department of Pediatric Hematology and Oncology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ali Ayçiçek
- Department of Pediatric Hematology and Oncology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Jung Y, Mallhi KK, Alcorn K, Saifee NH. Plasma-reduction for Apheresis Granulocyte transfusions in pediatric patients. Transfus Apher Sci 2024; 63:103879. [PMID: 38311500 DOI: 10.1016/j.transci.2024.103879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 02/06/2024]
Abstract
Granulocyte transfusion (GT) may be used to treat and prevent infections in patients with severe neutropenia or nonfunctioning granulocytes. For pediatric patients, the volume of granulocyte unit transfused is a crucial consideration given smaller blood volume and increased risk of volume overload compared to adults. There is limited literature on the optimal dosing or the maximum amount of granulocytes that can be tolerated, especially in pediatric patients. Additionally, no consensus exists regarding granulocyte collection method, frequency, or timing of GT initiation. Previous studies have described splitting or limiting collection volume for GT in pediatric patients, but these methods yield lower absolute neutrophil count (ANC) increment. Our blood supplier provides high-volume (0.5-1 L/unit), high-dose apheresis-collected granulocytes from donors stimulated with both granulocyte colony-stimulating factor and steroids. Here, we report cases of two pediatric patients with active infection undergoing bone marrow transplant with dramatic ANC increments (median one-hour ANC increment 5524/µL, interquartile range (IQR) 4417-10087; median 24-hour ANC increment 3880/µL, IQR 2550-5263) after infusing 100 mL plasma-reduced, apheresis collected GT. Our cases indicate that pediatric patients can tolerate 4-6 × 109/kg plasma-reduced GT and have detectable ANC with GT every 3 days.
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Affiliation(s)
- Yujung Jung
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA; Bloodworks Northwest, Seattle, WA, USA
| | - Kanwaldeep K Mallhi
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA; Division of Hematology and Oncology, Seattle Children's Hospital, Seattle, WA, USA
| | - Kirsten Alcorn
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA; Bloodworks Northwest, Seattle, WA, USA
| | - Nabiha H Saifee
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA; Department of Laboratory Medicine and Pathology, Seattle Children's, Seattle, WA, USA.
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Novel Insights into Fungal Infections Prophylaxis and Treatment in Pediatric Patients with Cancer. Antibiotics (Basel) 2022; 11:antibiotics11101316. [PMID: 36289974 PMCID: PMC9598217 DOI: 10.3390/antibiotics11101316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
Invasive fungal diseases (IFDs) are a relevant cause of morbidity and mortality in children with cancer. Their correct prevention and management impact patients’ outcomes. The aim of this review is to highlight the rationale and novel insights into antifungal prophylaxis and treatment in pediatric patients with oncological and hematological diseases. The literature analysis showed that IFDs represent a minority of cases in comparison to bacterial and viral infections, but their impact might be far more serious, especially when prolonged antifungal therapy or invasive surgical treatments are required to eradicate colonization. A personalized approach is recommended since pediatric patients with cancer often present with different complications and require tailored therapy. Moreover, while the Aspergillus infection rate does not seem to increase, in the near future, new therapeutic recommendations should be required in light of new epidemiological data on Candidemia due to resistant species. Finally, further studies on CAR-T treatment and other immunotherapies are needed in patients with unique needs and the risk of complications. Definitive guidelines on IFD treatment considering the evolving epidemiology of antifungal resistance, new therapeutic approaches in pediatric cancer, novel antifungal drugs and the importance of an appropriate antifungal stewardship are urgently needed.
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de Almeida-Neto C, Corso LM, Bassolli L, Witkin SS, Hamasaki DT, Albiero AL, Manangão CL, Mendrone-Junior A, Rocha V. Survival among children and adults treated with granulocyte transfusions: Twenty years' experience at a Brazilian blood center. Transfus Apher Sci 2021; 61:103300. [PMID: 34756651 DOI: 10.1016/j.transci.2021.103300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/08/2021] [Accepted: 10/23/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND It remains controversial whether granulocyte transfusions as a supportive treatment improve survival in patients with febrile neutropenia or granulocyte dysfunctions. We describe survival rates subsequent to granulocyte transfusions in pediatric and adults patients treated at a major blood center in Brazil. MATERIAL AND METHODS We retrospectively reviewed the clinical charts of pediatric and adult patients treated with granulocyte transfusions at our institution from January 2000 to October 2019. We assessed demographic characteristics, clinical features, indications for transfusion, units transfused, dose of granulocytes administered and survival rates 30 and 100 days after the initial transfusion. RESULTS We identified 64 pediatric and 67 adult patients treated with 262 granulocyte transfusions. An optimal dose (> 0.6 × 109 granulocytes per kilogram per transfused unit) was available for transfusion in 80.4 % of pediatric patients but in only 19.6 % of adults (p = 0.017). Thirty days after their first granulocyte transfusion, 38 (59.4 %) pediatric and 61 (91 %) adult patients had died. Patients receiving the optimal dose of granulocytes had better survival outcomes, but even among this sub-group, adults were more likely to die than were children either at 30 days (OR = 8.67, 95 %CI 2.69-34.9) or 100 days (OR = 6.27, 95 %CI 1.86-25.9) after their initial granulocyte transfusion. CONCLUSION Survival rates following granulocyte transfusion varied by the dose transfused and were higher in children than in adults.
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Affiliation(s)
- Cesar de Almeida-Neto
- Fundação Pró-Sangue - Hemocentro de São Paulo, São Paulo, SP, Brazil; Disciplina de Hematologia, Hemoterapia e Terapia Celular da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil; Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Lucas Machado Corso
- Disciplina de Hematologia, Hemoterapia e Terapia Celular da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Lucas Bassolli
- Disciplina de Hematologia, Hemoterapia e Terapia Celular da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil; Laboratório de Investigação Médica 31 (LIM-31) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Steven S Witkin
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, USA; Institute of Tropical Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Debora Toshie Hamasaki
- Fundação Pró-Sangue - Hemocentro de São Paulo, São Paulo, SP, Brazil; Disciplina de Hematologia, Hemoterapia e Terapia Celular da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Caroline Limoeiro Manangão
- Fundação Pró-Sangue - Hemocentro de São Paulo, São Paulo, SP, Brazil; Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Instituto do Tratamento do Câncer Infantil, São Paulo, Brazil
| | - Alfredo Mendrone-Junior
- Fundação Pró-Sangue - Hemocentro de São Paulo, São Paulo, SP, Brazil; Laboratório de Investigação Médica 31 (LIM-31) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- Fundação Pró-Sangue - Hemocentro de São Paulo, São Paulo, SP, Brazil; Disciplina de Hematologia, Hemoterapia e Terapia Celular da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil; Laboratório de Investigação Médica 31 (LIM-31) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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