title: Infectious complications following allogeneic HLA-identical sibling transplantation with antithymocyte globulin-based reduced intensity preparative regimen.
abstract: In the setting of reduced-intensity conditioning (RIC) regimens for allogeneic stem cell transplantation (allo-SCT), the epidemiology of transplant-related infections is still poorly defined. In 101 high-risk patients who received an HLA-identical sibling allo-SCT after RIC, including fludarabine, busulfan and antithymocyte globulin (ATG), we report during the first 6 months a cumulative incidence of positive CMV antigenemia of 42% (95% CI 32-52%), developing at a median of 37 (range 7-116) days without evidence of CMV disease (median follow-up, 434 days). The cumulative incidence of bacteremia was 25% (95% CI 17-33%), occurring at a median of 67 (range 7-172) days, while patients had recovered a full neutrophil count. In all, 65% of the bacteremia (95% CI 49-81%) were gram negative. The cumulative incidence of fungal infections was 8% (95% CI 3-13%), with a median onset of 89 (range 7-170) days. In multivariate analysis, stem cell source (bone marrow; P=0.0002) was significantly associated with the risk of positive CMV antigenemia, while higher doses of prednisone (>2 mg/kg) represented the major risk factor for bacteremia (P=0.0001). Infectious-related mortality was 5% (95% CI 1-9%), with aspergillosis being the principal cause. Collectively, these results suggest that prospective efforts are warranted to develop optimal antimicrobial preventive strategies after RIC allo-SCT.
authors.affiliation: Unité de Transplantation et de Thérapie Cellulaire, Institut Paoli-Calmettes, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Mohty
authors.forename: W
authors.initials: W
authors.lastname: Jacot
authors.forename: C
authors.initials: C
authors.lastname: Faucher
authors.forename: J O
authors.initials: JO
authors.lastname: Bay
authors.forename: C
authors.initials: C
authors.lastname: Zandotti
authors.forename: L
authors.initials: L
authors.lastname: Collet
authors.forename: B
authors.initials: B
authors.lastname: Choufi
authors.forename: K
authors.initials: K
authors.lastname: Bilger
authors.forename: O
authors.initials: O
authors.lastname: Tournilhac
authors.forename: N
authors.initials: N
authors.lastname: Vey
authors.forename: A M
authors.initials: AM
authors.lastname: Stoppa
authors.forename: D
authors.initials: D
authors.lastname: Coso
authors.forename: J A
authors.initials: JA
authors.lastname: Gastaut
authors.forename: P
authors.initials: P
authors.lastname: Viens
authors.forename: D
authors.initials: D
authors.lastname: Maraninchi
authors.forename: D
authors.initials: D
authors.lastname: Olive
authors.forename: D
authors.initials: D
authors.lastname: Blaise
mesh_terms: D000017:ABO Blood-Group System; D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology / Q000401:mortality; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology*; D001787:Blood Group Incompatibility; D003586:Cytomegalovirus Infections / Q000517:prevention & control; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006084:Graft Rejection / Q000453:epidemiology; D006086:Graft vs Host Disease / Q000453:epidemiology; D006650:Histocompatibility Testing; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D035781:Siblings; D033581:Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors; D014184:Transplantation, Homologous / Q000009:adverse effects*; D014777:Virus Diseases / Q000453:epidemiology / Q000209:etiology*
chemical_list: D000017:ABO Blood-Group System; D000998:Antiviral Agents; D015774:Ganciclovir