title: African American Race Is a Newly Identified Risk Factor for Postengraftment Blood Stream Infections in Pediatric Allogeneic Blood and Marrow Transplantation.
abstract: Blood stream infections (BSI) are a major source of morbidity and mortality both in allogeneic blood and marrow transplant (BMT) recipients. Various risk factors for BSI in BMT have been identified. The impact of race and cytomegalovirus (CMV) viremia, a common complication after engraftment, however, has not been rigorously assessed. This is important because both CMV infection and ganciclovir, the mainstay of pre-emptive therapy, have myelosuppressive and immunosuppressive effects. We conducted a retrospective analysis to test the hypothesis that race and CMV viremia predispose allogeneic BMT patients to postengraftment BSI. We analyzed 278 allogeneic BMT performed at Children's Healthcare of Atlanta between January 1, 2005 and December 31, 2014 that met eligibility criteria. We performed a multivariate analysis to estimate the effect of CMV viremia on risk for BSI in the postengraftment period (days +30 to 100). Risk for BSI was associated with CMV viremia (hazard ratio [HR], 3.34; 95% confidence interval [CI], 1.51 to 7.36; P = .003); grade III and IV acute graft-versus-host disease (HR, 3.28; 95% CI, 1.55 to 6.92; P = .002), and African American race (HR, 2.22; 95% CI, 1.09 to 4.51; P = .027). The results of our study highlight the importance of a novel risk factor for postengraftment BSI, not previously considered-African American race.
authors.affiliation: Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Sapporo Hokuyu Hospital, Sapporo, Japan. Electronic address: hirozumi.sano@gmail.com.
authors.forename: Hirozumi
authors.initials: H
authors.lastname: Sano
authors.affiliation: Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Hilinski
authors.affiliation: Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Kristy
authors.initials: K
authors.lastname: Applegate
authors.affiliation: Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Kuang-Yueh
authors.initials: KY
authors.lastname: Chiang
authors.affiliation: Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Ann
authors.initials: A
authors.lastname: Haight
authors.affiliation: Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Muna
authors.initials: M
authors.lastname: Qayed
authors.affiliation: Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: John
authors.initials: J
authors.lastname: Horan
mesh_terms: D000293:Adolescent; D001741:Black or African American; D064591:Allografts; D016470:Bacteremia / Q000208:ethnology* / Q000209:etiology; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000150:complications; D004198:Disease Susceptibility; D005260:Female; D030342:Genetic Diseases, Inborn / Q000628:therapy; D006402:Hematologic Diseases / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009503:Neutropenia / Q000150:complications; D012307:Risk Factors; D014766:Viremia / Q000208:ethnology* / Q000209:etiology; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: African American race; Blood and marrow transplantation; Blood stream infection; Cytomegalovirus viremia; Risk factor