title: Bloodstream infection after umbilical cord blood transplantation using reduced-intensity stem cell transplantation for adult patients.
abstract: Bloodstream infection (BSI) is a significant problem after cord blood transplantation (CBT). However, little information has been reported on BSI after reduced-intensity CBT (RI-CBT). We retrospectively reviewed the medical records of 102 patients. The median age of the patients was 55 years (range, 17-79 years). Preparative regimens comprised fludarabine 125 to 150 mg/m 2 , melphalan 80 to 140 mg/m 2 , or busulfan 8 mg/kg and total body irradiation 2 to 8 Gy. Prophylaxis against graft-versus-host disease comprised cyclosporin or tacrolimus. BSI developed within 100 days of RI-CBT in 32 patients. The cumulative incidence of BSI was 25% at day 30 and 32% at day 100. The median onset was day 15 (range, 1-98 days). Causative organisms included Pseudomonas aeruginosa (n = 12), Staphylococcus epidermidis (n = 11), Staphylococcus aureus (n = 6), Enterococcus faecium (n = 4), Enterococcus faecalis (n = 4), Stenotrophomonas maltophilia (n = 4), and others (n = 7). Of the 32 patients with BSI, 25 (84%) died within 100 days after RI-CBT. BSI was the direct cause of death in 8 patients (25%). Univariate analysis failed to identify any significant risk factors. BSI clearly represents a significant and fatal complication after RI-CBT. Further studies are warranted to determine clinical characteristics, identify patients at high risk of BSI, and establish therapeutic strategies.
authors.affiliation: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Narimatsu
authors.forename: Tomoko
authors.initials: T
authors.lastname: Matsumura
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kami
authors.forename: Shigesaburo
authors.initials: S
authors.lastname: Miyakoshi
authors.forename: Eiji
authors.initials: E
authors.lastname: Kusumi
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Takagi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Miura
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kato
authors.forename: Chiho
authors.initials: C
authors.lastname: Inokuchi
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Myojo
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Kishi
authors.forename: Naoko
authors.initials: N
authors.lastname: Murashige
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yuji
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Masuoka
authors.forename: Akiko
authors.initials: A
authors.lastname: Yoneyama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Wake
authors.forename: Shinichi
authors.initials: S
authors.lastname: Morinaga
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
authors.forename: Shuichi
authors.initials: S
authors.lastname: Taniguchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D036101:Cord Blood Stem Cell Transplantation / Q000401:mortality; D005260:Female; D006086:Graft vs Host Disease / Q000382:microbiology / Q000517:prevention & control; D006402:Hematologic Diseases / Q000628:therapy; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors