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Blood, Vol. 95 No. 12 (June 15), 2000:
pp. 3683-3686
Chronic graft versus host disease is associated with long-term
risk for pneumococcal infections in recipients of bone marrow
transplants
Samar Kulkarni,
Ray Powles,
Jennie Treleaven,
Unell Riley,
Seema Singhal,
Clive Horton,
Bhawna Sirohi,
Niyati Bhagwati,
Simon Meller,
Radovan Saso, and
Jayesh Mehta
From the Leukaemia and Myeloma Units, Royal Marsden Hospital,
Surrey, UK.
Incidences of and risk factors for Streptococcus pneumoniae
sepsis (SPS) after hematopoietic stem cell transplantation were analyzed in 1329 patients treated at a single center between 1973 and
1997. SPS developed in 31 patients a median of 10 months after transplantation (range, 3 to 187 months). The infection was fatal in 7 patients. The probability of SPS developing at 5 and 10 years was 4%
and 6%, respectively. Age, sex, diagnosis, and graft versus host
disease (GVHD) prophylaxis did not influence the development of SPS.
Allogeneic transplantation (10-year probability, 7% vs 3% for
nonallogeneic transplants; P = .03) and chronic GVHD
(10-year probability, 14% vs 4%; P = .002) were
associated with significantly higher risk for SPS. All the episodes of
SPS were seen in patients who had undergone allograft or total body
irradiation (TBI) (31 of 1202 vs 0 of 127;
P = .07). Eight patients were taking regular penicillin prophylaxis at the time of SPS, whereas 23 were not taking
any prophylaxis. None of the 7 patients with fatal infections was
taking prophylaxis for Pneumococcus. Pneumococcal bacteremia was associated with higher incidences of mortality (6 of 15 vs 1 of 16;
P = .04). We conclude that there is a significant long-term risk for pneumococcal infection in patients who have undergone allograft transplantation, especially those with chronic
GVHD. Patients who have undergone autograft transplantation after
TBI-containing regimens also appear to be at increased risk. These
patients should receive lifelong pneumococcus prophylaxis. Consistent
with increasing resistance to penicillin, penicillin prophylaxis
does not universally prevent SPS, though it may protect against fatal
infections. Further studies are required to determine the optimum
prophylactic strategy in patients at risk.
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