title: Infection Rates among Acute Leukemia Patients Receiving Alternative Donor Hematopoietic Cell Transplantation.
abstract: Alternative graft sources (umbilical cord blood [UCB], matched unrelated donors [MUD], or mismatched unrelated donors [MMUD]) enable patients without a matched sibling donor to receive potentially curative hematopoietic cell transplantation (HCT). Retrospective studies demonstrate comparable outcomes among different graft sources. However, the risk and types of infections have not been compared among graft sources. Such information may influence the choice of a particular graft source. We compared the incidence of bacterial, viral, and fungal infections in 1781 adults with acute leukemia who received alternative donor HCT (UCB, n= 568; MUD, n = 930; MMUD, n = 283) between 2008 and 2011. The incidences of bacterial infection at 1 year were 72%, 59%, and 65% (P < .0001) for UCB, MUD, and MMUD, respectively. Incidences of viral infection at 1 year were 68%, 45%, and 53% (P < .0001) for UCB, MUD, and MMUD, respectively. In multivariable analysis, bacterial, fungal, and viral infections were more common after either UCB or MMUD than after MUD (P < .0001). Bacterial and viral but not fungal infections were more common after UCB than MMUD (P = .0009 and <.0001, respectively). The presence of viral infection was not associated with an increased mortality. Overall survival (OS) was comparable among UCB and MMUD patients with Karnofsky performance status (KPS) ≥ 90% but was inferior for UCB for patients with KPS < 90%. Bacterial and fungal infections were associated with poorer OS. Future strategies focusing on infection prevention and treatment are indicated to improve HCT outcomes.
authors.affiliation: Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: kballen@partners.org.
authors.forename: Karen
authors.initials: K
authors.lastname: Ballen
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Kwang
authors.initials: K
authors.lastname: Woo Ahn
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Min
authors.initials: M
authors.lastname: Chen
authors.affiliation: Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California.
authors.forename: Hisham
authors.initials: H
authors.lastname: Abdel-Azim
authors.affiliation: Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Ahmed
authors.affiliation: Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Aljurf
authors.affiliation: Center for Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Joseph
authors.initials: J
authors.lastname: Antin
authors.affiliation: Stanford University School of Medicine, Stanford, California.
authors.forename: Ami S
authors.initials: AS
authors.lastname: Bhatt
authors.affiliation: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
authors.affiliation: Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: George
authors.initials: G
authors.lastname: Chen
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Christopher
authors.initials: C
authors.lastname: Dandoy
authors.affiliation: Christian Medical College, Vellore, India.
authors.forename: Biju
authors.initials: B
authors.lastname: George
authors.affiliation: Medical Director, Cleveland Cord Blood Center, Cleveland, Ohio.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Laughlin
authors.affiliation: Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.affiliation: Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: MacMillan
authors.affiliation: Section of Hematology, Oncology and BMT, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: David A
authors.initials: DA
authors.lastname: Margolis
authors.affiliation: Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.affiliation: Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Maxim
authors.initials: M
authors.lastname: Norkin
authors.affiliation: City of Hope National Medical Center, Duarte, California.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rosenthal
authors.affiliation: Division of Hematology/Oncology Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Ayman
authors.initials: A
authors.lastname: Saad
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Bipin
authors.initials: B
authors.lastname: Savani
authors.affiliation: Department of Hematology, Academische Ziekenhuis, Maastricht, Netherlands.
authors.forename: Harry C
authors.initials: HC
authors.lastname: Schouten
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jan
authors.initials: J
authors.lastname: Storek
authors.affiliation: Division of Blood and Marrow Transplantation, Children's National Health System, Washington, District of Columbia.
authors.forename: Paul
authors.initials: P
authors.lastname: Szabolcs
authors.affiliation: Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: Celalettin
authors.initials: C
authors.lastname: Ustun
authors.affiliation: Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Verneris
authors.affiliation: Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Waller
authors.affiliation: Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.affiliation: Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland.
authors.forename: Kirsten M
authors.initials: KM
authors.lastname: Williams
authors.affiliation: Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: John R
authors.initials: JR
authors.lastname: Wingard
authors.affiliation: Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington.
authors.forename: Baldeep
authors.initials: B
authors.lastname: Wirk
authors.affiliation: Division of Pediatrics, Wilhelmina Children's Hospital, Utrecht, Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: Wolfs
authors.affiliation: Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Jo-Anne H
authors.initials: JH
authors.lastname: Young
authors.affiliation: Host Defense Program, Divisions of Hematology/Oncology/Bone Marrow Transplant and Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Auletta
authors.affiliation: Adult Stem Cell Transplantation Program, University of Miami, Miami, Florida.
authors.forename: Krishna V
authors.initials: KV
authors.lastname: Komanduri
authors.affiliation: Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Caroline
authors.initials: C
authors.lastname: Lindemans
authors.affiliation: Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Marcie L
authors.initials: ML
authors.lastname: Riches
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006648:Histocompatibility; D006801:Humans; D015994:Incidence; D007239:Infections / Q000209:etiology* / Q000401:mortality; D007938:Leukemia / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D061349:Unrelated Donors; D055815:Young Adult
keywords: Infection; Leukemia; Umbilical cord blood