Infections in Infants with SCID: Isolation, Infection Screening, and Prophylaxis in PIDTC Centers

Morna J Dorsey, Nicola A M Wright, Natalia S Chaimowitz, Blachy J Dávila Saldaña, Holly Miller, Michael D Keller, Monica S Thakar, Ami J Shah, Rolla Abu-Arja, Jeffrey Andolina, Victor Aquino, J L Barnum, Jeffrey J Bednarski, Monica Bhatia, Francisco A Bonilla, Manish J Butte, Nancy J Bunin, Sharat Chandra, Sonali Chaudhury, Karin Chen, Hey Chong, Geoffrey D E Cuvelier, Jignesh Dalal, Magee L DeFelice, Kenneth B DeSantes, Lisa R Forbes, Alfred Gillio, Fred Goldman, Avni Y Joshi, Neena Kapoor, Alan P Knutsen, Lisa Kobrynski, Jay A Lieberman, Jennifer W Leiding, Benjamin Oshrine, Kiran P Patel, Susan Prockop, Troy C Quigg, Ralph Quinones, Kirk R Schultz, Christine Seroogy, David Shyr, Subhadra Siegel, Angela R Smith, Troy R Torgerson, Mark T Vander Lugt, Lolie C Yu, Morton J Cowan, Rebecca H Buckley, Christopher C Dvorak, Linda M Griffith, Elie Haddad, Donald B Kohn, Brent Logan, Luigi D Notarangelo, Sung-Yun Pai, Jennifer Puck, Michael A Pulsipher, Jennifer Heimall, Morna J Dorsey, Nicola A M Wright, Natalia S Chaimowitz, Blachy J Dávila Saldaña, Holly Miller, Michael D Keller, Monica S Thakar, Ami J Shah, Rolla Abu-Arja, Jeffrey Andolina, Victor Aquino, J L Barnum, Jeffrey J Bednarski, Monica Bhatia, Francisco A Bonilla, Manish J Butte, Nancy J Bunin, Sharat Chandra, Sonali Chaudhury, Karin Chen, Hey Chong, Geoffrey D E Cuvelier, Jignesh Dalal, Magee L DeFelice, Kenneth B DeSantes, Lisa R Forbes, Alfred Gillio, Fred Goldman, Avni Y Joshi, Neena Kapoor, Alan P Knutsen, Lisa Kobrynski, Jay A Lieberman, Jennifer W Leiding, Benjamin Oshrine, Kiran P Patel, Susan Prockop, Troy C Quigg, Ralph Quinones, Kirk R Schultz, Christine Seroogy, David Shyr, Subhadra Siegel, Angela R Smith, Troy R Torgerson, Mark T Vander Lugt, Lolie C Yu, Morton J Cowan, Rebecca H Buckley, Christopher C Dvorak, Linda M Griffith, Elie Haddad, Donald B Kohn, Brent Logan, Luigi D Notarangelo, Sung-Yun Pai, Jennifer Puck, Michael A Pulsipher, Jennifer Heimall

Abstract

Purpose: The Primary Immune Deficiency Treatment Consortium (PIDTC) enrolled children with severe combined immunodeficiency (SCID) in a prospective natural history study of hematopoietic stem cell transplant (HSCT) outcomes over the last decade. Despite newborn screening (NBS) for SCID, infections occurred prior to HSCT. This study's objectives were to define the types and timing of infection prior to HSCT in patients diagnosed via NBS or by family history (FH) and to understand the breadth of strategies employed at PIDTC centers for infection prevention.

Methods: We analyzed retrospective data on infections and pre-transplant management in patients with SCID diagnosed by NBS and/or FH and treated with HSCT between 2010 and 2014. PIDTC centers were surveyed in 2018 to understand their practices and protocols for pre-HSCT management.

Results: Infections were more common in patients diagnosed via NBS (55%) versus those diagnosed via FH (19%) (p = 0.012). Outpatient versus inpatient management did not impact infections (47% vs 35%, respectively; p = 0.423). There was no consensus among PIDTC survey respondents as to the best setting (inpatient vs outpatient) for pre-HSCT management. While isolation practices varied, immunoglobulin replacement and antimicrobial prophylaxis were more uniformly implemented.

Conclusion: Infants with SCID diagnosed due to FH had lower rates of infection and proceeded to HSCT more quickly than did those diagnosed via NBS. Pre-HSCT management practices were highly variable between centers, although uses of prophylaxis and immunoglobulin support were more consistent. This study demonstrates a critical need for development of evidence-based guidelines for the pre-HSCT management of infants with SCID following an abnormal NBS.

Trial registration: NCT01186913.

Keywords: Infections; hematopoietic stem cell transplant; newborn screening; primary immunodeficiency; prophylaxis; severe combined immunodeficiency.