Document Type
Article
Publication Date
2-2019
Identifier
DOI: 10.1016/j.bbmt.2018.09.031; PMCID: PMC6339825
Abstract
We analyzed late fatal infections (LFIs) in allogeneic stem cell transplantation (HCT) recipients reported to the Center for International Blood and Marrow Transplant Research. We analyzed the incidence, infection types, and risk factors contributing to LFI in 10,336 adult and 5088 pediatric subjects surviving for ≥2 years after first HCT without relapse. Among 2245 adult and 377 pediatric patients who died, infections were a primary or contributory cause of death in 687 (31%) and 110 (29%), respectively. At 12 years post-HCT, the cumulative incidence of LFIs was 6.4% (95% confidence interval [CI], 5.8% to 7.0%) in adults, compared with 1.8% (95% CI, 1.4% to 2.3%) in pediatric subjects; P < .001). In adults, the 2 most significant risks for developing LFI were increasing age (20 to 39, 40 to 54, and ≥55 years versus 18 to 19 years) with hazard ratios (HRs) of 3.12 (95% CI, 1.33 to 7.32), 3.86 (95% CI, 1.66 to 8.95), and 5.49 (95% CI, 2.32 to 12.99) and a history of chronic graft-versus-host disease GVHD (cGVHD) with ongoing immunosuppression at 2 years post-HCT compared with no history of GVHD with (HR, 3.87; 95% CI, 2.59 to 5.78). In pediatric subjects, the 3 most significant risks for developing LFI were a history of cGVHD with ongoing immunosuppression (HR, 9.49; 95% CI, 4.39 to 20.51) or without ongoing immunosuppression (HR, 2.7; 95% CI, 1.05 to 7.43) at 2 years post-HCT compared with no history of GVHD, diagnosis of inherited abnormalities of erythrocyte function compared with diagnosis of acute myelogenous leukemia (HR, 2.30; 95% CI, 1.19 to 4.42), and age >10 years (HR, 1.92; 95% CI, 1.15 to 3.2). This study emphasizes the importance of continued vigilance for late infections after HCT and institution of support strategies aimed at decreasing the risk of cGVHD.
Journal Title
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
Volume
25
Issue
2
First Page
362
Last Page
368
MeSH Keywords
Adolescent; Adult; Age Factors; Aged; Allografts; Child; Child, Preschool; Chronic Disease; Female; Hematopoietic Stem Cell Transplantation; Humans; Immunosuppression; Incidence; Infant; Infant, Newborn; Infections; Leukemia, Myeloid, Acute; Male; Middle Aged; Time Factors
Keywords
Adults; Hematopoietic cell transplantation; Infection; Late fatal infection; Pediatrics
Recommended Citation
Norkin M, Shaw BE, Brazauskas R, et al. Characteristics of Late Fatal Infections after Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant. 2019;25(2):362-368. doi:10.1016/j.bbmt.2018.09.031
Comments
Grant support
This article is available under the Creative Commons CC-BY-NC-ND license and permits non-commercial use of the work as published, without adaptation or alteration provided the work is fully attributed.
Publisher's Link: https://www.astctjournal.org/article/S1083-8791(18)30598-6/fulltext