Bloodstream infection after umbilical cord blood transplantation using reduced-intensity stem cell transplantation for adult patients.
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.
Narimatsu
Hiroto
H
Department of Hematology, Toranomon Hospital, Tokyo, Japan.
Matsumura
Tomoko
T
Kami
Masahiro
M
Miyakoshi
Shigesaburo
S
Kusumi
Eiji
E
Takagi
Shinsuke
S
Miura
Yuji
Y
Kato
Daisuke
D
Inokuchi
Chiho
C
Myojo
Tomohiro
T
Kishi
Yukiko
Y
Murashige
Naoko
N
Yuji
Koichiro
K
Masuoka
Kazuhiro
K
Yoneyama
Akiko
A
Wake
Atsushi
A
Morinaga
Shinichi
S
Kanda
Yoshinobu
Y
Taniguchi
Shuichi
S
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