Non-Tuberculous Mycobacterial Infection in Hematopoietic Cell Transplant
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LETTER TO EDITOR
Non-Tuberculous Mycobacterial Infection in Hematopoietic Cell Transplant Anthony Sabulski 1,2 Sharat Chandra 1,2
&
Stella M. Davies 1,2 & Grant Paulsen 1,3 & Ashish Kumar 1,2 & Michael Grimley 1,2 &
Received: 10 July 2020 / Accepted: 24 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
To the Editor: Non-tuberculous mycobacteria (NTM) include all mycobacteria other than Mycobacterium tuberculosis, Mycobacterium bovis, and Mycobacterium leprae. NTM infections occur more commonly in patients with a compromised immune system, including patients undergoing hematopoietic cell transplantation (HCT) [1–3]. Immunosuppression alone is a risk factor for developing these infections, but primary immune deficiency disorders such as Mendelian susceptibility to mycobacterial disease (MSMD) and germline guanine-adenine–thymine–adenine 2 (GATA2) deficiency further increase the risk of NTM infection and may also require HCT for definitive therapy [4]. A prior study of 132 pediatric patients undergoing HCT revealed that 6.4% of allogeneic HCTs were complicated by NTM infection [1]. Similarly, Weinstock et al. reported 9.7% of T cell–depleted allogeneic HCTs are complicated by NTM infection [2]. Asymptomatic central line–associated infections are the most common manifestation of NTM and generally do not have severe clinical consequences. However, invasive disseminated disease, most commonly in the lungs, does occur and is clinically important [2]. Multiagent treatment regimens for NTM infections are available, but data on efficacy in HCT are limited. The goals of our study were to investigate the effect of NTM therapy on engraftment and determine the duration of NTM therapy needed to prevent recurrence of NTM infections. Out of 464 allogeneic HCTs performed at our institution between 2014 and
* Anthony Sabulski [email protected] 1
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
2
Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA
3
Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
2019, invasive NTM infection complicated pre- and/or post-HCT courses in five patients (1.1%). Noninvasive or asymptomatic NTM infections were not studied. NTM infections were classified according to the Infectious Disease Society of America guidelines for pulmonary infections and Centers for Disease Control guidelines for extrapulmonary infections. Full donor chimerism (FDC) was defined as whole-blood donor chimerism > 90%, and mixed chimerism was defined as whole-blood donor chimerism < 90%. Chimerism studies were performed using XY fluorescence in situ hybridization for sex mismatched donors or short-term tandem repeat (STR) analysis for same sex donors. Standard published criteria were used to characterize acute and chronic GvHD [5]. Patient demographics and NTM infection characteristics are shown in Table 1. Median ag
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