Bacterial blood stream infections (BSIs), particularly post-engraftment BSIs, are associated with increased mortality after allogeneic hematopoietic cell transplantation.

Abstract

We analyzed CIBMTR data to evaluate the incidence of non-relapse mortality (NRM) and association with overall survival (OS) for bacterial blood stream infections (BSIs) occurring within 100 days of alloHCT in 2 different phases: pre-/peri-engraftment (BSI very early phase, BSI-VEP) and BSI post-engraftment (BSI occurring between 2 weeks after engraftment and day 100, late early phase, BSI-LEP). Of the 7128 alloHCT patients, 2656 (37%) had ≥1 BSI by day 100. BSI-VEP, BSI-LEP, and BSI-Both constituted 56% (n = 1492), 31% (n = 824), and 13% (n = 340) of total BSI, respectively. Starting in 2009, we observed a gradual decline in BSI incidence through 2012 (61-48%). Patients with BSI-VEP were more likely to receive a myeloablative conditioning (MAC) regimen with total body irradiation (TBI). NRM was significantly higher in patients with any BSI (RR 1.82 95% CI 1.63-2.04 for BSI-VEP, RR 2.46, 95% CI 2.05-2.96 for BSI-LEP, and RR 2.29, 95% CI 1.87-2.81 for BSI-Both) compared with those without BSI. OS was significantly lower in patients with any BSI compared with patients without BSI (RR 1.36, 95% CI 1.26-1.47 for BSI-VEP; RR 1.83, 95% CI 1.58-2.12 for BSI-LEP: RR 1.66, 95% CI 1.43-1.94 for BSI-Both). BSIs within day 100 after alloHCT are common and remain a risk factor for mortality.

• Authors: Celalettin Ustun, Jo-Anne H Young, Genovefa A Papanicolaou, Soyoung Kim, Kwang Woo Ahn, Min Chen, Hisham Abdel-Azim, Mahmoud Aljurf, Amer Beitinjaneh, Valerie Brown, Jan Cerny, Saurabh Chhabra, Mohamed A Kharfan-Dabaja, Parastoo B Dahi, Andrew Daly, Christopher E Dandoy, Christopher C Dvorak, Cesar O Freytes, Shahrukh Hashmi, Hillard Lazarus, Per Ljungman, Taiga Nishihori, Kristin Page, Sai R K Pingali, Ayman Saad, Bipin N Savani, Daniel Weisdorf, Kirsten Williams, Baldeep Wirk, Jeffery J Auletta, Caroline A Lindemans, Krishna Komanduri, Marcie Riches
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 54 Issue 8 Pg. 1254-1265 (08 2019) ISSN: 1476-5365 [Electronic] England
• PMID: 30546070 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S., Research Support, U.S. Gov't, P.H.S.)

Topics

• Adolescent
• Adult
• Bacteremia (etiology, mortality)
• Child
• Female
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Humans
• Male
• Middle Aged
• Mortality
• Risk Factors
• Transplantation Conditioning (adverse effects)
• Transplantation, Homologous (methods)
• Young Adult