Increased overall and bacterial infections following myeloablative allogeneic HCT for patients with AML in CR1.

Abstract

Presumably, reduced-intensity/nonmyeloablative conditioning (RIC/NMA) for allogeneic hematopoietic cell transplantation (alloHCT) results in reduced infections compared with myeloablative conditioning (MAC) regimens; however, published evidence is limited. In this Center for International Blood and Marrow Transplant Research study, 1755 patients (aged ≥40 years) with acute myeloid leukemia in first complete remission were evaluated for infections occurring within 100 days after T-cell replete alloHCT. Patients receiving RIC/NMA (n = 777) compared with those receiving MAC (n = 978) were older and underwent transplantation more recently; however, the groups were similar regarding Karnofsky performance score, HCT-comorbidity index, and cytogenetic risk. One or more infections occurred in 1045 (59.5%) patients (MAC, 595 [61%]; RIC/NMA, 450 [58%]; P = .21) by day 100. The median time to initial infection after MAC conditioning occurred earlier (MAC, 15 days [range, <1-99 days]; RIC/NMA, 21 days [range, <1-100 days]; P < .001). Patients receiving MAC were more likely to experience at least 1 bacterial infection by day 100 (MAC, 46% [95% confidence interval (CI), 43-49]; RIC/NMA, 37% [95% CI, 34-41]; P = .0004), whereas at least a single viral infection was more prevalent in the RIC/NMA cohort (MAC, 34% [95% CI, 31-37]; RIC/NMA, 39% [95% CI, 36-42]; P = .046). MAC remained a risk factor for bacterial infections in multivariable analysis (relative risk, 1.44; 95% CI, 1.23-1.67; P < .0001). Moreover, the rate of any infection per patient-days at risk in the first 100 days (infection density) after alloHCT was greater for the MAC cohort (1.21; 95% CI, 1.11-1.32; P < .0001). RIC/NMA was associated with reduced infections, especially bacterial infections, in the first 100 days after alloHCT.

• Authors: Celalettin Ustun, Soyoung Kim, Min Chen, Amer M Beitinjaneh, Valerie I Brown, Parastoo B Dahi, Andrew Daly, Miguel Angel Diaz, Cesar O Freytes, Siddhartha Ganguly, Shahrukh Hashmi, Gerhard C Hildebrandt, Hillard M Lazarus, Taiga Nishihori, Richard F Olsson, Kristin M Page, Genovefa Papanicolaou, Ayman Saad, Sachiko Seo, Basem M William, John R Wingard, Baldeep Wirk, Jean A Yared, Miguel-Angel Perales, Jeffery J Auletta, Krishna V Komanduri, Caroline A Lindemans, Marcie L Riches
• Journal: Blood advances (Blood Adv) Vol. 3 Issue 17 Pg. 2525-2536 (09 10 2019) ISSN: 2473-9537 [Electronic] United States
• PMID: 31471322 (Publication Type: Comparative Study, 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.)
• Copyright: © 2019 by The American Society of Hematology.

Chemical References

• Myeloablative Agonists

Topics

• Adult
• Bacterial Infections (etiology)
• Hematopoietic Stem Cell Transplantation (adverse effects, methods)
• Humans
• Infections (etiology)
• Leukemia, Myeloid, Acute (complications, therapy)
• Myeloablative Agonists (adverse effects, therapeutic use)
• Remission Induction
• Time Factors
• Transplantation Conditioning (adverse effects, methods)
• Transplantation, Homologous (adverse effects)
• Treatment Outcome