Post-transplantation cyclophosphamide is associated with increased bacterial infections Journal Article

   


Authors: Ustun, C.; Chen, M.; Kim, S.; Auletta, J. J.; Batista, M. V.; Battiwalla, M.; Cerny, J.; Gowda, L.; Hill, J. A.; Liu, H.; Munshi, P. N.; Nathan, S.; Seftel, M. D.; Wingard, J. R.; Chemaly, R. F.; Dandoy, C. E.; Perales, M. A.; Riches, M.; Papanicolaou, G. A.
Article Title: Post-transplantation cyclophosphamide is associated with increased bacterial infections
Abstract: Post-transplant cyclophosphamide (PTCy) is increasingly used to reduce graft-versus-host disease after hematopoietic cell transplantation (HCT); however, it might be associated with more infections. All patients who were ≥2 years old, receiving haploidentical or matched sibling donor (Sib) HCT for acute leukemias or myelodysplastic syndrome, and either calcineurin inhibitor (CNI)- or PTCy-based GVHD prophylaxis [Haploidentical HCT with PTCy (HaploCy), 757; Sibling with PTCy (SibCy), 403; Sibling with CNI-based (SibCNI), 1605] were included. Most bacterial infections occurred within the first 100 days; 953 patients (34.5%) had at least 1 infection and 352 patients (13%) had ≥2 infections. Patients receiving PTCy had a greater incidence of bacterial infections by day 180 [HaploCy 46%; SibCy 48%; SibCNI 35%; p < 0.001]. Compared with the SibCNI without infection cohort, 1.99-fold, 3.33-fold, 2.78-fold, and 2.53-fold increased TRM was seen for the HaploCy cohort without infection and HaploCy, SibCy, and SibCNI cohorts with infection, respectively. Bacterial infections increased mortality [HaploCy (HR1.84, 99% CI: 1.45–2.33, p < 0.0001), SibCy cohort (HR,1.68, 99% CI: 1.30–2.19, p < 0.0001), and SibCNI cohort (HR,1.76, 99% CI: 1.43–2.16, p < 0.0001). PTCy was associated with increased bacterial infections regardless of donor, and bacterial infections were associated with increased mortality irrespective of GVHD prophylaxis. Patients receiving PTCy should be monitored carefully for bacterial infections following PTCy. © 2023, The Author(s), under exclusive licence to Springer Nature Limited.
Keywords: adolescent; adult; child; controlled study; preschool child; aged; child, preschool; retrospective studies; human cell; major clinical study; overall survival; clinical feature; mortality; postoperative period; disease association; incidence; cohort analysis; cyclophosphamide; hematopoietic stem cell transplantation; retrospective study; age; acute leukemia; myelodysplastic syndrome; donor; tissue donors; graft versus host reaction; calcineurin inhibitor; graft vs host disease; bacterial infection; bacterial infections; humans; human; male; female; article; haploidentical transplantation; infectious agent; matched sibling donor; calcineurin inhibitors
Journal Title: Bone Marrow Transplantation
Volume: 59
Issue: 1
ISSN: 0268-3369
Publisher: Nature Publishing Group  
Date Published: 2024-01-01
Start Page: 76
End Page: 84
Language: English
DOI: 10.1038/s41409-023-02131-z
PUBMED: 37903992
PROVIDER: scopus
PMCID: PMC11164622
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85175257429&doi=10.1038%2fs41409-023-02131-z&partnerID=40&md5=a3d957b0438527ca91ffb510c354b2e4
Notes: Article -- Source: Scopus
Altmetric
What is Altmetric?
Citation Impact
What is Dimensions Citation Badge?
BMJ Impact Analytics
MSK Authors
  1. Genovefa A Papanicolaou
    238 Papanicolaou
  2. Miguel-Angel Perales
    918 Perales
Related MSK Work