title: Serious infections after unrelated donor transplantation in 136 children: impact of stem cell source.
abstract: How the infection risks compare after umbilical cord blood (UCB) and bone marrow (BM) transplantation is not known. Therefore, we compared serious infections in the 2 years after pediatric myeloablative unrelated donor transplantation with unmanipulated BM (n = 52), T cell-depleted (TCD) BM (n = 24), or UCB (n = 60) for the treatment of hematologic malignancy. Overall, the cumulative incidence of 1 or more serious infections was comparable between groups (BM, 81%; TCD, 83%; UCB, 90%; P = .12). Furthermore, by taking all serious infections into account and using multivariate techniques with unmanipulated BM as the reference, there were also no significant differences between groups (TCD relative risk [RR], 1.6; P = .10; UCB RR, 1.0; P = .84). Within the time periods days 0 to 42, days 43 to 100, and days 101 to 180, the only difference was a greater risk of viral infections from days 0 to 42 in TCD recipients (RR, 3.5; P = .02). Notably, after day 180, TCD recipients had a significantly increased infection risk (RR, 3.1; P = .03), whereas the risk in UCB recipients (RR, 0.5; P = .23) was comparable to that in BM recipients. Other factors associated with an increased infection risk in the 2 years after transplantation were age > or = 8 years, graft failure, and severe acute graft-versus-host disease. These data suggest that the risk of serious infection after pediatric UCB transplantation is comparable to that with unmanipulated BM.
authors.affiliation: Division of Medical Hematology, Oncology, and Transplantation, University of Minnesota Blood and Marrow Transplant Program, Minneapolis, Minnesota, USA. barke014@umn.edu
authors.forename: Juliet N
authors.initials: JN
authors.lastname: Barker
authors.forename: Rachael E
authors.initials: RE
authors.lastname: Hough
authors.forename: Jo-Anne H
authors.initials: JA
authors.lastname: van Burik
authors.forename: Todd E
authors.initials: TE
authors.lastname: DeFor
authors.forename: Margaret L
authors.initials: ML
authors.lastname: MacMillan
authors.forename: Michele R
authors.initials: MR
authors.lastname: O'Brien
authors.forename: John E
authors.initials: JE
authors.lastname: Wagner
mesh_terms: D000293:Adolescent; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D006648:Histocompatibility; D006801:Humans; D015994:Incidence; D007223:Infant; D008212:Lymphocyte Depletion; D008297:Male; D009894:Opportunistic Infections / Q000209:etiology*; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D014019:Tissue Donors