Microbiologically documented infections after adult allogeneic hematopoietic cell transplantation: A 5-year analysis within the Swiss Transplant Cohort study.

Abstract

BACKGROUND:

Infections are an important complication after allogeneic hematopoietic cell transplantation (allo-HCT). The present study aimed at determining the landscape of infections occurring in a large cohort of allo-HCT patients, as well as associated risk factors for infections and for one-year non-relapse mortality.

METHODS:

This is a retrospective cohort study using STCS and EBMT databases to assess the one-year incidence rate of infection, as well as risk factors for infections and for one-year non-relapse mortality among adult allo-HCT patients transplanted between 2010 and 2014 in Switzerland. Univariable and multivariable quasi-Poisson and multivariable Cox regression models were used.

RESULTS:

Of 553 patients included, 486 had an infection with a global incidence rate of 3.66 infections per patient-year. Among a total of 1534 infections analyzed, viral infections were predominant (n = 1138, 74.2%), followed by bacterial (n = 343, 22.4%) and fungal (n = 53, 3.5%) infections. At one year, the cumulative incidence of relapse and non-relapse mortality was 26% and 16%, respectively. 195 (35.3%) of patients had at least one episode of severe graft-versus-host-disease (GvHD). A center effect was observed, and underlying disease, donor type, cytomegalovirus serological constellation, and GvHD were also associated with the incidence rate of infections. There was an increased risk for one-year non-relapse mortality associated with all pathogens, specifically within two months of infection, and this remained true beyond 2 months of a fungal infection.

CONCLUSION:

Despite advances to limit infections in this population, they still occur in most allo-HCT patients with a major impact on survival at 1 year.

• Authors: Diem-Lan Vu, Julie-Anne Dayer, Stavroula Masouridi-Levrat, Christophe Combescure, Elsa Boely, Nina Khanna, Nicolas J Mueller, Martina Kleber, Michael Medinger, Joerg Halter, Jakob Passweg, Antonia M Müller, Urs Schanz, Yves Chalandon, Dionysios Neofytos, Christian van Delden, Laurent Kaiser, Swiss Transplant Cohort Study
• Journal: Transplant infectious disease : an official journal of the Transplantation Society (Transpl Infect Dis) Vol. 22 Issue 4 Pg. e13289 (Aug 2020) ISSN: 1399-3062 [Electronic] Denmark
• PMID: 32277837 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: © 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Topics

• Adolescent
• Adult
• Aged
• Bacterial Infections (epidemiology)
• Databases, Factual
• Female
• Hematopoietic Stem Cell Transplantation (adverse effects, mortality)
• Humans
• Male
• Middle Aged
• Mycoses (epidemiology)
• Proportional Hazards Models
• Recurrence
• Retrospective Studies
• Risk Factors
• Switzerland
• Time Factors
• Transplantation, Homologous (adverse effects, mortality)
• Virus Diseases (epidemiology)
• Young Adult