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Biol Blood Marrow Transplant. 2016 Sep;22(9):1636-1645. doi: 10.1016/j.bbmt.2016.06.012. Epub 2016 Jun 22.

Infection Rates among Acute Leukemia Patients Receiving Alternative Donor Hematopoietic Cell Transplantation.

Author information

1
Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: kballen@partners.org.
2
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
3
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
4
Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California.
5
Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
6
Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia.
7
Center for Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
8
Stanford University School of Medicine, Stanford, California.
9
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
10
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York.
11
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
12
Christian Medical College, Vellore, India.
13
Medical Director, Cleveland Cord Blood Center, Cleveland, Ohio.
14
Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio.
15
Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
16
Section of Hematology, Oncology and BMT, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
17
Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
18
Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida.
19
City of Hope National Medical Center, Duarte, California.
20
Division of Hematology/Oncology Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
21
Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
22
Department of Hematology, Academische Ziekenhuis, Maastricht, Netherlands.
23
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
24
Division of Blood and Marrow Transplantation, Children's National Health System, Washington, District of Columbia.
25
Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
26
Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
27
Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland.
28
Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington.
29
Division of Pediatrics, Wilhelmina Children's Hospital, Utrecht, Netherlands.
30
Host Defense Program, Divisions of Hematology/Oncology/Bone Marrow Transplant and Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio.
31
Adult Stem Cell Transplantation Program, University of Miami, Miami, Florida.
32
Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht, Netherlands.
33
Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Abstract

Alternative graft sources (umbilical cord blood [UCB], matched unrelated donors [MUD], or mismatched unrelated donors [MMUD]) enable patients without a matched sibling donor to receive potentially curative hematopoietic cell transplantation (HCT). Retrospective studies demonstrate comparable outcomes among different graft sources. However, the risk and types of infections have not been compared among graft sources. Such information may influence the choice of a particular graft source. We compared the incidence of bacterial, viral, and fungal infections in 1781 adults with acute leukemia who received alternative donor HCT (UCB, n= 568; MUD, n = 930; MMUD, n = 283) between 2008 and 2011. The incidences of bacterial infection at 1 year were 72%, 59%, and 65% (P < .0001) for UCB, MUD, and MMUD, respectively. Incidences of viral infection at 1 year were 68%, 45%, and 53% (P < .0001) for UCB, MUD, and MMUD, respectively. In multivariable analysis, bacterial, fungal, and viral infections were more common after either UCB or MMUD than after MUD (P < .0001). Bacterial and viral but not fungal infections were more common after UCB than MMUD (P = .0009 and <.0001, respectively). The presence of viral infection was not associated with an increased mortality. Overall survival (OS) was comparable among UCB and MMUD patients with Karnofsky performance status (KPS) ≥ 90% but was inferior for UCB for patients with KPS < 90%. Bacterial and fungal infections were associated with poorer OS. Future strategies focusing on infection prevention and treatment are indicated to improve HCT outcomes.

KEYWORDS:

Infection; Leukemia; Umbilical cord blood

PMID:
27343716
PMCID:
PMC5008458
DOI:
10.1016/j.bbmt.2016.06.012
[Indexed for MEDLINE]
Free PMC Article

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