Reduction of infection-related mortality after allogeneic PBSCT from HLA-identical siblings: longitudinal analysis from 1994 to 2008 at a single institution.
Infection-related mortality (IRM) is responsible for a major proportion of all cases of non-relapse mortality (NRM) after allogeneic PBSCT (alloPBSCT). We analyzed 580 consecutive adults who received a first alloPBSCT from an HLA-identical sibling from 1994 to 2008 at a single institution to describe the severe infections and report the incidence, causes and risk factors for IRM and NRM. Both IRM and NRM decreased with time; within the period of 1994-2000, the 2-year incidence of IRM and NRM was 22 and 31%, respectively, vs 11 and 16% within the period of 2001-2008 (P<0.05 for both comparisons). In multivariate analysis, the variables that increased IRM were within the earlier period of 1994-2000 (P<0.01), poor performance status (P<0.01), grade II-IV acute GVHD (P<0.001) and invasive fungal infection (IFI) (P<0.001) or CMV disease (P<0.001) after transplant. With respect to NRM, earlier time period was also identified as a risk factor (P<0.001), as well as IFIs (P<0.001) and CMV disease (P<0.001). The intensity of the conditioning regimen had no effect on IRM and NRM. These results showed a significant reduction in IRM and NRM over a period of 15 years. The development of IFIs and CMV disease continue to have an impact on NRM.
Martino
R
R
Department of Hematology and Stem Cell Transplantation, Hospital de la Sant Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain. rmartino@santpau.cat
Kerguelen
A
A
Valcárcel
D
D
Sureda
A
A
Fachini
L
L
Piñana
J L
JL
Briones
J
J
Delgado
J
J
Brunet
S
S
Sierra
J
J
D000328:Adult; D016470:Bacteremia / Q000401:mortality; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007239:Infections / Q000401:mortality*; D007938:Leukemia / Q000401:mortality; D015999:Multivariate Analysis; D009181:Mycoses / Q000209:etiology / Q000401:mortality; D009190:Myelodysplastic Syndromes / Q000401:mortality; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D012008:Recurrence; D035781:Siblings; D014184:Transplantation, Homologous / Q000009:adverse effects; D014777:Virus Diseases / Q000401:mortality