Infectious complications following allogeneic HLA-identical sibling transplantation with antithymocyte globulin-based reduced intensity preparative regimen.
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.
Mohty
M
M
Unité de Transplantation et de Thérapie Cellulaire, Institut Paoli-Calmettes, Marseille, France.
Jacot
W
W
Faucher
C
C
Bay
J O
JO
Zandotti
C
C
Collet
L
L
Choufi
B
B
Bilger
K
K
Tournilhac
O
O
Vey
N
N
Stoppa
A M
AM
Coso
D
D
Gastaut
J A
JA
Viens
P
P
Maraninchi
D
D
Olive
D
D
Blaise
D
D
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*
D000017:ABO Blood-Group System; D000998:Antiviral Agents; D015774:Ganciclovir