title: Pre-engraftment bloodstream infections in acute leukemia patients undergoing unrelated cord blood transplantation following intensified myeloablative conditioning without ATG.
abstract: The aim of this study is to investigate the impact of pre-engraftment bloodstream infections (BSIs) on the outcomes in acute leukemia patients undergoing myeloablative cord blood transplantation (CBT). A total of 226 acute leukemia patients who received unrelated CBT were enrolled in this study, and all these patients received an intensified myeloablative conditioning without ATG. Pre-engraftment BSIs occurred in 72 patients (31.9 %), and the median time of onset was 4.5 days after cord blood infusion, BSIs of gram-negative bacilli, and gram-positive cocci comprised of 63.8 and 36.2 %, respectively. The cumulative incidences of neutrophil and platelet engraftment, acute or chronic graft versus host disease (GVHD) were comparable among the non-BSI, gram-negative bacilli BSI, and gram-positive cocci BSI groups. The cumulative incidence of transplant-related mortality (TRM), relapse, overall survival (OS), and disease-free survival (DFS) was similar between the non-BSI and the BSI groups. For subgroups analysis, TRM was lower in gram-positive cocci BSI patients compared with that of gram-negative bacilli BSI patients (8.3 vs 39.3 %) (p = 0.01) (HR = 0.39, p = 0.034), and the 5-year OS was higher in gram-positive cocci BSI cohort (79.1 vs 44.2 %) (p = 0.01) (HR = 0.36, p = 0.046). Our study demonstrated that, for acute leukemia patients who received CBT after myeloablative conditioning that omitted ATG, pre-engraftment BSI had no impact on engraftment, GVHD, TRM, relapse, and long-term survival. Due to the fact that gram-negative bacilli BSI was associated with poor outcomes compared with gram-positive cocci BSI, appropriate early empirical antimicrobial management strategies and better supportive care are required to decrease the gram-negative bacilli BSI-related mortality.
authors: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Lujiang Road No 19, Hefei, 230001, China.
authors: Changcheng
authors: C
authors: Zheng
authors: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Lujiang Road No 19, Hefei, 230001, China.
authors: Baolin
authors: B
authors: Tang
authors: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Lujiang Road No 19, Hefei, 230001, China.
authors: Xiaoyu
authors: X
authors: Zhu
authors: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Lujiang Road No 19, Hefei, 230001, China.
authors: Xuhan
authors: X
authors: Zhang
authors: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Lujiang Road No 19, Hefei, 230001, China.
authors: Lei
authors: L
authors: Zhang
authors: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Lujiang Road No 19, Hefei, 230001, China.
authors: Liangquan
authors: L
authors: Geng
authors: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Lujiang Road No 19, Hefei, 230001, China.
authors: Huilan
authors: H
authors: Liu
authors: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Lujiang Road No 19, Hefei, 230001, China. zmsun_vip@163.com.
authors: Zimin
authors: Z
authors: Sun
mesh_terms: D000293:Adolescent; D000328:Adult; D000961:Antilymphocyte Serum; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000175:diagnosis* / Q000453:epidemiology; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods* / Q000401:mortality; D061349:Unrelated Donors; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum
keywords: Acute leukemia; Bloodstream infection; Cord blood transplantation; Myeloablative conditioning