Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation · 2016
Infection Rates among Acute Leukemia Patients Receiving Alternative Donor Hematopoietic Cell Transplantation.
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Ballen Karen, Woo Ahn Kwang, Chen Min, Abdel-Azim Hisham, Ahmed Ibrahim, Aljurf Mahmoud, Antin Joseph, Bhatt Ami S, Boeckh Michael, Chen George, Dandoy Christopher, George Biju, Laughlin Mary J, Lazarus Hillard M, MacMillan Margaret L, Margolis David A, Marks David I, Norkin Maxim, Rosenthal Joseph, Saad Ayman, Savani Bipin, Schouten Harry C, Storek Jan, Szabolcs Paul, Ustun Celalettin, Verneris Michael R, Waller Edmund K, Weisdorf Daniel J, Williams Kirsten M, Wingard John R, Wirk Baldeep, Wolfs Tom, Young Jo-Anne H, Auletta Jeffrey, Komanduri Krishna V, Lindemans Caroline, Riches Marcie L
Аннотация
Alternative graft sources (umbilical cord blood [UCB], matched unrelated donors [MUD], or mismatched unrelated donors [MMUD]) enable patients without a matched sibling donor to receive potentially curative hematopoietic cell transplantation (HCT). Retrospective studies demonstrate comparable outcomes among different graft sources. However, the risk and types of infections have not been compared among graft sources. Such information may influence the choice of a particular graft source. We compared the incidence of bacterial, viral, and fungal infections in 1781 adults with acute leukemia who received alternative donor HCT (UCB, n= 568; MUD, n = 930; MMUD, n = 283) between 2008 and 2011. The incidences of bacterial infection at 1 year were 72%, 59%, and 65% (P < .0001) for UCB, MUD, and MMUD, respectively. Incidences of viral infection at 1 year were 68%, 45%, and 53% (P < .0001) for UCB, MUD, and MMUD, respectively. In multivariable analysis, bacterial, fungal, and viral infections were more common after either UCB or MMUD than after MUD (P < .0001). Bacterial and viral but not fungal infections were more common after UCB than MMUD (P = .0009 and <.0001, respectively). The presence of viral infection was not associated with an increased mortality. Overall survival (OS) was comparable among UCB and MMUD patients with Karnofsky performance status (KPS) ≥ 90% but was inferior for UCB for patients with KPS < 90%. Bacterial and fungal infections were associated with poorer OS. Future strategies focusing on infection prevention and treatment are indicated to improve HCT outcomes.