Infections after T-replete haploidentical transplantation and high-dose cyclophosphamide as graft-versus-host disease prophylaxis.

Abstract

BACKGROUND:

Recently, a platform of T-cell replete haploidentical hematopoietic stem cell transplantation (haplo-HSCT) using post-transplant cyclophosphamide (Cy) has shown high reproducibility and acceptable safety profile.

METHOD:

This prospective cohort analysis allowed us to collect data on infections among 70 consecutive recipients of haplo-HSCT affected by various hematologic malignancies.

RESULTS:

After a median follow-up of 23 months, cumulative incidence of viral infections was 70% (95% confidence interval [CI] 59-81) at 100 days and 77% (95% CI 67-87) at 1 year; 35 of 65 patients at risk had CMV reactivation (54%) and the rate of polyomavirus-virus-associated cystitis was 19% (13/70). Cumulative incidence of bacterial and fungal infections at 1 year were 63% (95% CI 51-75) and 12% (95% CI 4-19), respectively. Of note, only 1 invasive fungal infection occurred beyond 1 year after transplant (day +739).

CONCLUSION:

In conclusion, despite a high rate of viral infections in the early period, present data suggest a satisfactory infectious profile after T-cell replete haplo-HSCT using post-transplant Cy. These results may help clinicians to improve both prophylactic and therapeutic antimicrobial strategies in this emerging haploidentical setting.

• Authors: R Crocchiolo, S Bramanti, A Vai, B Sarina, R Mineri, E Casari, F Tordato, E Mauro, I Timofeeva, E Lugli, D Mavilio, C Carlo-Stella, A Santoro, L Castagna
• Journal: Transplant infectious disease : an official journal of the Transplantation Society (Transpl Infect Dis) Vol. 17 Issue 2 Pg. 242-9 (Apr 2015) ISSN: 1399-3062 [Electronic] Denmark
• PMID: 25648539 (Publication Type: Journal Article)
• Copyright: © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Immunosuppressive Agents
• Cyclophosphamide

Topics

• Adult
• Aged
• Bacterial Infections (epidemiology, etiology, immunology)
• Cohort Studies
• Cyclophosphamide (administration & dosage, adverse effects)
• Cystitis (epidemiology, etiology, immunology)
• Cytomegalovirus Infections (epidemiology, etiology, immunology)
• Female
• Graft vs Host Disease (prevention & control)
• Haplotypes
• Hematologic Neoplasms (therapy)
• Hematopoietic Stem Cell Transplantation (methods)
• Humans
• Immunocompromised Host
• Immunosuppressive Agents (administration & dosage, adverse effects)
• Incidence
• Male
• Middle Aged
• Mycoses (epidemiology, etiology, immunology)
• Polyomavirus Infections (epidemiology, etiology, immunology)
• Prospective Studies
• Transplantation Conditioning
• Virus Diseases (epidemiology, etiology, immunology)
• Young Adult