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

Authors: Ustun, C.; Kim, S.; Chen, M.; Beitinjaneh, A. M.; Brown, V. I.; Dahi, P. B.; Daly, A.; Diaz, M. A.; Freytes, C. O.; Ganguly, S.; Hashmi, S.; Hildebrandt, G. C.; Lazarus, H. M.; Nishihori, T.; Olsson, R. F.; Page, K. M.; Papanicolaou, G.; Saad, A.; Seo, S.; William, B. M.; Wingard, J. R.; Wirk, B.; Yared, J. A.; Perales, M. A.; Auletta, J. J.; Komanduri, K. V.; Lindemans, C. A.; Riches, M. L.
Article Title: 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 receivingMAC 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]; P5.046). 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 alloHCTwas 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. © 2019 by The American Society of Hematology.
Journal Title: Blood Advances
Volume: 3
Issue: 17
ISSN: 2473-9529
Publisher: American Society of Hematology  
Date Published: 2019-09-10
Start Page: 2525
End Page: 2536
Language: English
DOI: 10.1182/bloodadvances.2019000226
PUBMED: 31471322
PROVIDER: scopus
PMCID: PMC6737406
Notes: Article -- Export Date: 1 October 2019 -- Source: Scopus
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MSK Authors
  1. Miguel-Angel Perales
    395 Perales
  2. Parastoo Bahrami Dahi
    95 Dahi