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

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. WilliamJohn R. Wingard, Baldeep Wirk, Jean A. Yared, Miguel Angel Perales, Jeffery J. Auletta, Krishna V. Komanduri, Caroline A. Lindemans, Marcie L. Riches

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)2525-2536
Number of pages12
JournalBlood Advances
Volume3
Issue number17
DOIs
StatePublished - Sep 10 2019

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All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

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., ... Riches, M. L. (2019). Increased overall and bacterial infections following myeloablative allogeneic HCT for patients with AML in CR1. Blood Advances, 3(17), 2525-2536. https://doi.org/10.1182/bloodadvances.2019000226