title: Infections of the Central Nervous System after Unrelated Donor Umbilical Cord Blood Transplantation or Human Leukocyte Antigen-Matched Sibling Transplantation.
abstract: We analyzed the incidence, clinical characteristics, prognostic factors, and outcome of central nervous system (CNS) infections in consecutive patients with receiving umbilical cord blood transplantation (UCBT) (n = 343) or HLA-matched sibling donor stem cell transplantation (MST) (n = 366). Thirty-four CNS infections were documented at a median time of 116 days after transplantation (range, 7 to 1161). The cumulative incidence (CI) risk of developing a CNS infection was .6% at day +30, 2.3% at day +90, and 4.9% at 5 years. The 5-year CI of CNS infection was 8.2% after UCBT and 1.7% after MST (P < .001). The causative micro-organisms of CNS infections were fungi (35%), virus (32%), Toxoplasma spp. (12%), and bacteria (12%). Fungal infections occurred in 11 patients after UCBT and 1 after MST and were due to Aspergillus spp. (n = 8), Cryptococcus neoformans (n = 2), Scedosporium prolificans (n = 1), and Mucor (n = 1). Except for 1 patient, all died from CNS fungal infection. Viral infections occurred in 9 patients after UCBT and 1 after MST and were due to human herpes virus 6 (n = 7), cytomegalovirus (n = 2), and varicella zoster virus (n = 1). CNS toxoplasmosis was diagnosed in 3 patients after UCBT and 1 after MST. Other pathogens were Staphylococcus spp, Nocardia spp, Streptococcus pneumoniae, and Mycobacterium tuberculosis. Twenty of the 34 patients (59%) died from the CNS infection. In multivariable analysis, UCBT and disease stage beyond first complete remission were independently associated with the risk of developing CNS infections. The 5-year overall survival was 19% in patients who developed a CNS and 39% for those who did not (P = .006). In conclusion, our study showed that CNS infections are a significant clinical problem after stem cell transplantation associated with poor survival. They were more frequent after UCBT compared to MST.
authors: Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain. Electronic address: aitabalag@gmail.com.
authors: Aitana
authors: A
authors: Balaguer Rosello
authors: Neurology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Luis
authors: L
authors: Bataller
authors: Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Ignacio
authors: I
authors: Lorenzo
authors: Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Isidro
authors: I
authors: Jarque
authors: Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Miguel
authors: M
authors: Salavert
authors: Microbiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Eva
authors: E
authors: González
authors: Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: José Luis
authors: JL
authors: Piñana
authors: Neurology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Teresa
authors: T
authors: Sevilla
authors: Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Pau
authors: P
authors: Montesinos
authors: Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Gloria
authors: G
authors: Iacoboni
authors: Neurology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Nuria
authors: N
authors: Muelas
authors: Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Samuel
authors: S
authors: Romero
authors: Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Carlos
authors: C
authors: Carretero
authors: Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Juan
authors: J
authors: Montoro
authors: Neurology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Maria Jose
authors: MJ
authors: Ibáñez-Juliá
authors: Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Medicine, Universidad de Valencia, Valencia, Spain.
authors: Guillermo
authors: G
authors: Sanz
authors: Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Medicine, Universidad de Valencia, Valencia, Spain.
authors: Miguel Ángel
authors: MÁ
authors: Sanz
authors: Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Medicine, Universidad de Valencia, Valencia, Spain.
authors: Jaime
authors: J
authors: Sanz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000209:etiology; D002494:Central Nervous System Infections / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006680:HLA Antigens / Q000032:analysis*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006648:Histocompatibility; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology; D035781:Siblings; D013997:Time Factors; D014123:Toxoplasmosis / Q000209:etiology; D061349:Unrelated Donors; D014777:Virus Diseases / Q000209:etiology; D055815:Young Adult
chemical_list: D006680:HLA Antigens
keywords: Allogeneic stem cell transplantation; Encephalitis; Infections; Neurologic complications; Umbilical cord blood