Invasive Pneumococcal Disease After Hematopoietic Cell Transplantation for Sickle Cell Disease

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BACKGROUND: Children with sickle cell disease (SCD) remain at risk for invasive pneumococcal disease (IPD) because of impaired splenic function and increased susceptibility to encapsulated bacteria. Data describing IPD after allogeneic hematopoietic cell transplantation (HCT) for SCD are limited. METHODS: We conducted a multicenter retrospective cohort study of children and young adults with SCD undergoing first allogeneic HCT at two participating Sickle Cell Transplant Advocacy and Research (STAR) centers. IPD occurring within 365 days after HCT was identified through registry data, microbiologic culture review, and supplemental chart review. RESULTS: Among 182 patients undergoing HCT, three developed IPD within the first year after transplant. All cases presented with sepsis and bacteremia; one patient also developed meningitis and died of septic shock. IPD occurred between 7 and 365 days after HCT. None of the patients had received post-transplant pneumococcal vaccination before IPD diagnosis. Serotype data were unavailable for all cases. CONCLUSION: In this multicenter cohort of patients with SCD undergoing allogeneic HCT, IPD was uncommon but clinically severe, including late infections occurring nearly one year after transplantation. Prospective studies evaluating immune recovery, splenic function, pneumococcal vaccination practices, and long-term infectious outcomes are needed to better define persistent susceptibility to invasive pneumococcal disease after HCT in patients with SCD.

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