title: Distinct clinical features of infectious complications in adult T cell leukemia/lymphoma patients after allogeneic hematopoietic stem cell transplantation: a retrospective analysis in the Nagasaki transplant group.
abstract: Although allogeneic hematopoietic stem cell transplantation (allo-SCT) is performed as a curative option in adult T cell leukemia-lymphoma (ATL) patients, its high transplantation-related mortality raises a serious issue. The clinical features of infectious complications after transplantation are not well known. To analyze the impact of infections after allo-SCT for ATL, we retrospectively compared infectious complications in 210 patients at 3 institutions in Nagasaki prefecture between 1997 and 2009. There were 91 patients with acute myeloid leukemia (AML), 51 with acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL), and 68 with ATL. No patient received ganciclovir or foscarvir as prophylaxis, and most patients received antifungal prophylaxis with fluconazole or itraconazole. The cumulative incidence of cytomegalovirus (CMV) infection at 3 years was 69.2% in ATL patients versus 54.4% in AML patients (P = .0255). Cumulative infection-related mortality was significantly higher in ATL patients than in the 2 other groups (ATL versus AML, P = .0496; ATL versus ALL/LBL, P = .0075), and most death-causing pathogens were bacteria and fungus. The appearance of CMV infection was negatively associated with infectious mortality in ATL patients, but the P value for this association was near the borderline of significance (P = .0569). In multivariate analysis, transplantation using unrelated bone marrow and episodes of CMV infection were associated with worse overall survival in ATL patients, but were not in either AML or ALL/LBL patients. Collectively, the impact of infectious complications after transplantation in ATL patients was different from that in AML and ALL/LBL patients, suggesting that a more intensive strategy for infection control in ATL patients is required to reduce infectious mortality.
authors: Department of Hematology, Sasebo City General Hospital, Sasebo, Japan.
authors: Hidehiro
authors: H
authors: Itonaga
authors: Jun
authors: J
authors: Taguchi
authors: Takuya
authors: T
authors: Fukushima
authors: Hideki
authors: H
authors: Tsushima
authors: Shinya
authors: S
authors: Sato
authors: Koji
authors: K
authors: Ando
authors: Yasushi
authors: Y
authors: Sawayama
authors: Emi
authors: E
authors: Matsuo
authors: Reishi
authors: R
authors: Yamasaki
authors: Yasuyuki
authors: Y
authors: Onimaru
authors: Daisuke
authors: D
authors: Imanishi
authors: Yoshitaka
authors: Y
authors: Imaizumi
authors: Shinichiro
authors: S
authors: Yoshida
authors: Tomoko
authors: T
authors: Hata
authors: Yukiyoshi
authors: Y
authors: Moriuchi
authors: Sumihisa
authors: S
authors: Honda
authors: Yasushi
authors: Y
authors: Miyazaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003586:Cytomegalovirus Infections / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D007564:Japan; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D014184:Transplantation, Homologous
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D015725:Fluconazole