title: Early infections in adults undergoing matched related and matched unrelated/mismatched donor stem cell transplantation: a comparison of incidence.
abstract: We compared the incidence of early infectious complications between matched related (MR) and matched unrelated/mismatched (MU/MM) allogeneic stem cell transplant (allo-SCT) recipients in a single centre over a 6-year period in 214 consecutive adult patients. Early infections were defined as occurring from hospital admission for SCT until discharge. One hundred and fifty-nine patients received an allograft from MR donors and 55 patients received MU/MM allo-SCT. One hundred and eight of 214 patients had 147 episodes of fever. Ninety-three episodes (63%) were due to clinically or microbiologically documented infections and 54 episodes (37%) to fever not related to infection. Patients undergoing MU/MM transplantation tended to have more documented infections compared to recipients of MR allo-SCT (P = 0.06). Significantly more MU/MM transplant recipients had breakthrough infections with Herpes simplex virus type 1 (HSV-1, P = 0.003), and more CMV reactivation (P = 0.015). The mortality rate in all patients during hospitalisation post-SCT was 6.3% in MR and 18.2% in MU/MM allo-SCT recipients (P = 0.009). Early mortality was associated with infection in 70% of the patients, with a similar distribution between MR and MU/MM transplant recipients. However, MU/MM transplant recipients had significantly more early deaths due to toxic causes (P < 0.001). We conclude that early post-transplant MU/MM transplant recipients tend to have more documented infections, and have significantly more breakthrough infections with HSV-1 and more CMV reactivation. MU/MM transplant recipients are at higher risk of early mortality, especially due to toxic causes.
authors.affiliation: Department of Haematology, University Medical Centre, Utrecht, The Netherlands.
authors.forename: M G J
authors.initials: MG
authors.lastname: van Kraaij
authors.forename: L F
authors.initials: LF
authors.lastname: Verdonck
authors.forename: M
authors.initials: M
authors.lastname: Rozenberg-Arska
authors.forename: A W
authors.initials: AW
authors.lastname: Dekker
mesh_terms: D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000209:etiology / Q000382:microbiology; D005260:Female; D005334:Fever / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006648:Histocompatibility; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology / Q000382:microbiology; D009894:Opportunistic Infections / Q000209:etiology / Q000276:immunology* / Q000401:mortality; D012189:Retrospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000276:immunology / Q000401:mortality; D014777:Virus Diseases / Q000209:etiology / Q000382:microbiology