title: Increased risk of bacterial infection after engraftment in patients treated with allogeneic bone marrow transplantation following reduced-intensity conditioning regimen.
abstract: Although bacterial infection is a major cause of death even after reduced-intensity conditioning (RIC) for allogeneic stem cell transplantation (SCT), little is known about the epidemiology and risk factors. The incidence of bacterial infection in 43 patients who received allogeneic bone marrow transplantation (BMT) using a RIC regimen was compared with that in 68 patients who received BMT using a myeloablative conditioning regimen, and risk factors for bacterial infection were identified. Before engraftment, incidences of febrile neutropenia (FN) and documented infections (DI) were significantly decreased in RIC patients (FN: 59.5% vs. 89.6%, P<0.01, DI: 4.8% vs. 17.9%, P<0.01). However, incidence of bacterial infection was significantly increased in RIC patients in the post-engraftment phase (53.8% vs. 11.1%, log-rank, P<0.01). Blood stream was the most frequent focus of infection in both groups. In multivariate analysis, RIC and acute graft-versus-host disease were revealed to be significant risk factors for bacterial infection in this phase. In summary, risk of bacterial infection after engraftment was significantly higher in RIC patients, although infection was decreased before engraftment, and we need to develop a RIC-specific strategy against bacterial infection after RIC SCT.
authors.affiliation: Department of Hematology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. shigema@med.hokudai.ac.jp
authors.forename: A
authors.initials: A
authors.lastname: Shigematsu
authors.forename: S
authors.initials: S
authors.lastname: Yamamoto
authors.forename: J
authors.initials: J
authors.lastname: Sugita
authors.forename: T
authors.initials: T
authors.lastname: Kondo
authors.forename: M
authors.initials: M
authors.lastname: Onozawa
authors.forename: K
authors.initials: K
authors.lastname: Kahata
authors.forename: T
authors.initials: T
authors.lastname: Endo
authors.forename: S
authors.initials: S
authors.lastname: Shiratori
authors.forename: S
authors.initials: S
authors.lastname: Ota
authors.forename: K
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: K
authors.initials: K
authors.lastname: Wakasa
authors.forename: M
authors.initials: M
authors.lastname: Takahata
authors.forename: H
authors.initials: H
authors.lastname: Goto
authors.forename: S
authors.initials: S
authors.lastname: Ito
authors.forename: R
authors.initials: R
authors.lastname: Takemura
authors.forename: J
authors.initials: J
authors.lastname: Tanaka
authors.forename: S
authors.initials: S
authors.lastname: Hashino
authors.forename: M
authors.initials: M
authors.lastname: Nishio
authors.forename: T
authors.initials: T
authors.lastname: Koike
authors.forename: M
authors.initials: M
authors.lastname: Asaka
authors.forename: M
authors.initials: M
authors.lastname: Imamura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology*; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000401:mortality; D002405:Catheterization, Central Venous / Q000009:adverse effects; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous