title: Fungal and viral infections after allogeneic hematopoietic transplantation from unrelated donors in adults: improving outcomes over time.
abstract: Umbilical cord blood (CB) is increasingly used as an alternative source of stem cells in adult unrelated transplantation. Although registry studies report similar overall outcomes in comparison with BM/PB, comparative studies focusing on severe infections and infection-RM (IRM) with a long follow-up are scarce. A total of 434 consecutive unrelated transplants (1997-2009) were retrospectively analyzed to compare overall outcomes, incidence and risk factors of severe viral and invasive fungal infections in CB (n=65) vs BM/PB recipients (n=369). The 5-year OS was 38 vs 43%, respectively (P=0.2). CB transplantation (CBT) was associated with a higher risk of invasive aspergillosis (100-days-cumulative incidence 16 vs 6%, P=0.04) and CMV infection without differences in RM. No statistically significant differences were found regarding NRM (NRM of 38% in CB vs 37% in BM/PB at 1 year) nor IRM (30% in CB vs 27% in BM/PB at 1 year). In the overall population, NRM and IRM improved in more recent years. In adults who receive a single CBT, the risk of severe infections is increased when compared with unrelated BM/PB recipients, but mortality from infections is similar, leading to similar NRM and survival.
authors.affiliation: Division of Clinical Hematology, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Parody
authors.affiliation: Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Martino
authors.affiliation: Division of Clinical Hematology, Hospital de la Princesa, Madrid, Spain.
authors.forename: R
authors.initials: R
authors.lastname: de la Cámara
authors.affiliation: Division of Clinical Hematology, Hospital de la Princesa, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: García-Noblejas
authors.affiliation: Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Esquirol
authors.affiliation: Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Garcia-Cadenas
authors.affiliation: Division of Clinical Hematology, Hospital Clínico Universitario de Salamanca, Barcelona, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Villaescusa
authors.affiliation: Division of Clinical Hematology, Hospital Clínico Universitario de Salamanca, Barcelona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Caballero
authors.affiliation: Division of Clinical Hematology, Hospital Clínic i Provincial, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Rovira
authors.affiliation: Division of Clinical Hematology, Hospital Clínic i Provincial, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Fernandez-Avilés
authors.affiliation: Division of Clinical Hematology, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: F J
authors.initials: FJ
authors.lastname: Marquez-Malaver
authors.affiliation: Division of Clinical Hematology, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Espigado
authors.affiliation: Division of Clinical Hematology, Hospital Morales Meseguer, Murcia, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Castilla-Llorente
authors.affiliation: Division of Clinical Hematology, Hospital Morales Meseguer, Murcia, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Heras
authors.affiliation: Division of Clinical Hematology, Hospital Puerta del Hierro, Madrid, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Cabero
authors.affiliation: Division of Clinical Hematology, Hospital Puerta del Hierro, Madrid, Spain.
authors.forename: J R
authors.initials: JR
authors.lastname: Cabrera
authors.affiliation: Division of Clinical Hematology, Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Barba
authors.affiliation: Division of Clinical Hematology, Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Valcarcel
authors.affiliation: Division of Clinical Hematology, Hospital Duran i Reynalds, ICO, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Sánchez-Ortega
authors.affiliation: Division of Clinical Hematology, Hospital Duran i Reynalds, ICO, Barcelona, Spain.
authors.forename: R F
authors.initials: RF
authors.lastname: Duarte
authors.affiliation: Division of Clinical Hematology, Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Serrano
authors.affiliation: Division of Clinical Hematology, Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Carretero
authors.affiliation: Division of Clinical Hematology, Hospital Clínico Universitario de Salamanca, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Vazquez
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology / Q000401:mortality; D012042:Registries; D012189:Retrospective Studies; D061349:Unrelated Donors; D014777:Virus Diseases / Q000209:etiology / Q000401:mortality