title: Fewer infections and lower infection-related mortality following non-myeloablative versus myeloablative conditioning for allotransplantation of patients with lymphoma.
abstract: Non-myeloablative (NMA) allogeneic donor SCT for patients with relapsed lymphoma is associated with lower treatment-related mortality (TRM). However, the impact of conditioning intensity on post transplant infections remains unclear. We evaluated infections in 141 consecutive patients with lymphoma who were allografted using NMA (n=76) or myeloablative (MA; n=65) conditioning regimens. Using infection incidence density per 1000 patient days, we accounted for all infectious episodes during the first post transplant year. Before neutrophil engraftment, the NMA cohort had a 53% lower rate of bacterial infection (relative risk=0.47; P=0.06), whereas after engraftment the density of bacterial infections was similar in the two groups. In the first month, both invasive fungal infections and viral infections were twofold less frequent (P=0.22; P=0.06) in NMA patients. Late viral and fungal infections as well as CMV reactivation were infrequent after either conditioning intensity. The 1-year infection-related mortality was significantly lower after NMA conditioning (NMA 9% (3-16%) vs MA 22% (11-40%); P=0.03). NMA allogeneic transplantation for lymphoma patients results in substantially fewer early infections and lower infection-related deaths, although the similar frequency of later infections suggests that immune reconstitution is delayed with either conditioning intensity.
authors.affiliation: Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN 55455, USA. bach0173@umn.edu
authors.forename: V
authors.initials: V
authors.lastname: Bachanova
authors.forename: C G
authors.initials: CG
authors.lastname: Brunstein
authors.forename: L J
authors.initials: LJ
authors.lastname: Burns
authors.forename: J S
authors.initials: JS
authors.lastname: Miller
authors.forename: X
authors.initials: X
authors.lastname: Luo
authors.forename: T
authors.initials: T
authors.lastname: Defor
authors.forename: J-A H
authors.initials: JA
authors.lastname: Young
authors.forename: D J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: M
authors.initials: M
authors.lastname: Tomblyn
mesh_terms: D000328:Adult; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007239:Infections / Q000209:etiology* / Q000401:mortality; D008223:Lymphoma / Q000382:microbiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000379:methods*