title: Risk factors for late infections after allogeneic hematopoietic stem cell transplantation from a matched related donor.
abstract: After allogeneic hematopoietic stem cell transplantation (HSCT), early infections represent a major cause of morbidity and mortality but little information has been previously reported on late infections. Late infection incidence and risk factors were retrospectively determined in 196 long-term survivors after HLA matched related HSCT. Patients transplanted for aplastic anemia, chronic myelogenous leukemia (CML), and acute myelogenous leukemia (AML) were included. Median follow-up was 8 years. Thirty patients died beyond the first year, causes of death were relapse (n = 10) and infections (n = 19, associated with graft-versus-host disease [GVHD] in 16 patients). Late severe bacterial (LSB) and fungal infections occurred in 30 and 8 patients, yielding to an 8-year cumulative incidence of 15 (95%CI: 10-20) and 4% (95%CI: 1-6), respectively. The majority of viral infections were hepatitis C (HCV) and VZV (8-year cumulative incidence: 10 (95%CI: 5-14) and 27% (95%CI: 20-34), respectively. Three risk factors for LSB have been identified in multiple Cox analysis: CMV status (positive recipient and negative donor) (hazard ratio [HR]: 2.5, 95%CI: 1.1-5.9, P = .033), irradiation-based conditioning regimen (HR: 3.1, 95%CI: 1.2-7.8, P = .016), and extensive chronic GVHD (cGVHD; HR: 2.9, 95%CI: 1.3-6.9, P = .013). Extensive cGVHD was the only risk factor for non-HCV viral infections in patients transplanted for AML or CML (HR: 2.7, 95%CI: 1.4-5.1, P = .002). After HSCT, patients remain at high risk of infections even late after transplantation, in particular, with the above risk factors, and required a prolonged follow-up.
authors.affiliation: Service d'Hématologie, Greffe Hôpital Saint Louis, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
authors.forename: Raphaël
authors.initials: R
authors.lastname: Porcher
authors.forename: Renato
authors.initials: R
authors.lastname: De Castro Araujo
authors.forename: Régis Peffault
authors.initials: RP
authors.lastname: de Latour
authors.forename: Agnès
authors.initials: A
authors.lastname: Devergie
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.forename: Jérome
authors.initials: J
authors.lastname: Larghero
authors.forename: Lionel
authors.initials: L
authors.lastname: Adès
authors.forename: Patricia
authors.initials: P
authors.lastname: Ribaud
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Mary
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
mesh_terms: D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000628:therapy; D001424:Bacterial Infections / Q000453:epidemiology*; D005260:Female; D005602:France / Q000453:epidemiology; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000628:therapy; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D008297:Male; D009181:Mycoses / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors; D014184:Transplantation, Homologous / Q000009:adverse effects; D014777:Virus Diseases / Q000453:epidemiology*