{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T02:35:32Z","timestamp":1791858932115,"version":"4.3.4"},"reference-count":45,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100001422","name":"American Society of Hematology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001422","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Complement C5 inhibition can be used to treat hematopoietic cell transplant\u2010associated thrombotic microangiopathy (TA\u2010TMA) but may impact infectious organism clearance, impeding opsonization and lysis. The infectious risks of eculizumab exposure after hematopoietic cell transplant (HCT) are unknown. In this single center, retrospective case\u2013control study, we included allogeneic HCT recipients transplanted from January 2019 to January 2023. All patients with TA\u2010TMA treated with eculizumab from day 14\u2013180 post HCT were identified as cases. Controls were matched using an exact matching procedure on maximum grade 3\u20134 acute GVHD and intensive care unit admission. Cases and controls were matched on index date (first day of eculizumab therapy), and infections from 1\u2009year of index date were captured. Among 31 pairs (62 patients), the rate of bacteremia was 8.49 times higher (95% CI 4.4, 16.4), tissue specific bacterial infections 6.22 times higher (95% CI 2.28, 17.17), and viral infections 3.16 times higher (95% CI 1.90, 5.25) in eculizumab exposed children compared to matched controls. After adjusting for the number of immune suppressive medications, steroid days exposed, and steroid refractory GVHD, all infection rates remained significantly higher among eculizumab exposed patients. In sensitivity models excluding an outlier and altering the study follow up time to 3 and 6\u2009months, rates of infections remained significantly higher in the eculizumab cohort. Infection related mortality was significantly higher in the eculizumab exposed patients than controls; 1\u2010yr mortality was 45% vs 19% respectively. This study suggests infectious complications are increased with eculizumab treatment in the HCT setting, though additional studies are needed to validate these findings.<\/jats:p>","DOI":"10.1002\/ajh.70022","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:49:23Z","timestamp":1753876163000},"page":"1779-1791","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Eculizumab is Associated With Increased Infection Rates and Infection Related Mortality in Children With Thrombotic Microangiopathy After\n                    <scp>HCT<\/scp>"],"prefix":"10.1002","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4565-6399","authenticated-orcid":false,"given":"Michelle L.","family":"Schoettler","sequence":"first","affiliation":[{"name":"Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center Emory University  Atlanta Georgia 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Aflac Cancer and Blood Disorders Center Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suhag","family":"Parikh","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanmuganathan","family":"Chandrakasan","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor","family":"Fitch","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Obordo","sequence":"additional","affiliation":[{"name":"Children's 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