Chronic graft versus host disease is associated with long-term risk for pneumococcal infections in recipients of bone marrow transplants

Incidences of and risk factors for Streptococcus pneumoniae sepsis (SPS) af ter hematopoietic stem cell transplantation were analyzed in 1329 patients treated at a single center between 1973 and 1997, SPS developed in 31 patie nts a median of 10 months after transplantation (range, 3 to 187 months). T he 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 nonallo geneic transplants; P = .03) and chronic GVHD (10-year probability, 14% vs 4%; P = .002) were associated with significantly higher risk for SPS, All t he episodes of SPS were seen in patients who had undergone allograft or tot al 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 infectio ns was taking prophylaxis for Pneumococcus, Pneumococcal bacteremia was ass ociated 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 inf ection in patients who have undergone allograft transplantation, especially those with chronic GVHD, Patients who have undergone autograft transplanta tion after TBI-containing regimens also appear to be at increased risk. The se patients should receive lifelong pneumococcus prophylaxis, Consistent wi th increasing resistance to penicillin, penicillin prophylaxis does not uni versally prevent SPS, though it may protect against fatal infections. Furth er studies are required to determine the optimum prophylactic strategy in p atients at risk. (C) 2000 by The American Society of Hematology.