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

Karen Ballen, Kwang Woo Ahn, Min Chen, Hisham Abdel-Azim, Ibrahim Ahmed, Mahmoud Aljurf, Joseph Antin, Ami S. Bhatt, Michael Boeckh, George Chen, Christopher Dandoy, Biju George, Mary J. Laughlin, Hillard M. Lazarus, Margaret L. MacMillan, David A. Margolis, David I. Marks, Maxim Norkin, Joseph Rosenthal, Ayman SaadBipin Savani, Harry C. Schouten, Jan Storek, Paul Szabolcs, Celalettin Ustun, Michael R. Verneris, Edmund K. Waller, Daniel J. Weisdorf, Kirsten M. Williams, John R. Wingard, Baldeep Wirk, Tom Wolfs, Jo Anne H. Young, Jeffrey Auletta, Krishna V. Komanduri, Caroline Lindemans, Marcie L. Riches

Research output: Contribution to journalArticle

23 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1636-1645
Number of pages10
JournalBiology of Blood and Marrow Transplantation
Volume22
Issue number9
DOIs
StatePublished - Sep 1 2016

Fingerprint

Unrelated Donors
Cell Transplantation
Leukemia
Tissue Donors
Fetal Blood
Infection
Mycoses
Virus Diseases
Bacterial Infections
Transplants
Karnofsky Performance Status
Incidence
Survival
Siblings
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

Cite this

Ballen, Karen ; Woo Ahn, Kwang ; Chen, Min ; Abdel-Azim, Hisham ; Ahmed, Ibrahim ; Aljurf, Mahmoud ; Antin, Joseph ; Bhatt, Ami S. ; Boeckh, Michael ; Chen, George ; Dandoy, Christopher ; George, Biju ; Laughlin, Mary J. ; Lazarus, Hillard M. ; MacMillan, Margaret L. ; Margolis, David A. ; Marks, David I. ; Norkin, Maxim ; Rosenthal, Joseph ; Saad, Ayman ; Savani, Bipin ; Schouten, Harry C. ; Storek, Jan ; Szabolcs, Paul ; Ustun, Celalettin ; Verneris, Michael R. ; Waller, Edmund K. ; Weisdorf, Daniel J. ; Williams, Kirsten M. ; Wingard, John R. ; Wirk, Baldeep ; Wolfs, Tom ; Young, Jo Anne H. ; Auletta, Jeffrey ; Komanduri, Krishna V. ; Lindemans, Caroline ; Riches, Marcie L. / Infection Rates among Acute Leukemia Patients Receiving Alternative Donor Hematopoietic Cell Transplantation. In: Biology of Blood and Marrow Transplantation. 2016 ; Vol. 22, No. 9. pp. 1636-1645.
@article{b3d89e7409164ad69cb5246de60fad75,
title = "Infection Rates among Acute Leukemia Patients Receiving Alternative Donor Hematopoietic Cell Transplantation",
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.",
author = "Karen Ballen and {Woo Ahn}, Kwang and Min Chen and Hisham Abdel-Azim and Ibrahim Ahmed and Mahmoud Aljurf and Joseph Antin and Bhatt, {Ami S.} and Michael Boeckh and George Chen and Christopher Dandoy and Biju George and Laughlin, {Mary J.} and Lazarus, {Hillard M.} and MacMillan, {Margaret L.} and Margolis, {David A.} and Marks, {David I.} and Maxim Norkin and Joseph Rosenthal and Ayman Saad and Bipin Savani and Schouten, {Harry C.} and Jan Storek and Paul Szabolcs and Celalettin Ustun and Verneris, {Michael R.} and Waller, {Edmund K.} and Weisdorf, {Daniel J.} and Williams, {Kirsten M.} and Wingard, {John R.} and Baldeep Wirk and Tom Wolfs and Young, {Jo Anne H.} and Jeffrey Auletta and Komanduri, {Krishna V.} and Caroline Lindemans and Riches, {Marcie L.}",
year = "2016",
month = "9",
day = "1",
doi = "10.1016/j.bbmt.2016.06.012",
language = "English (US)",
volume = "22",
pages = "1636--1645",
journal = "Biology of Blood and Marrow Transplantation",
issn = "1083-8791",
publisher = "Elsevier Inc.",
number = "9",

}

Ballen, K, Woo Ahn, K, Chen, M, Abdel-Azim, H, Ahmed, I, Aljurf, M, Antin, J, Bhatt, AS, Boeckh, M, Chen, G, Dandoy, C, George, B, Laughlin, MJ, Lazarus, HM, MacMillan, ML, Margolis, DA, Marks, DI, Norkin, M, Rosenthal, J, Saad, A, Savani, B, Schouten, HC, Storek, J, Szabolcs, P, Ustun, C, Verneris, MR, Waller, EK, Weisdorf, DJ, Williams, KM, Wingard, JR, Wirk, B, Wolfs, T, Young, JAH, Auletta, J, Komanduri, KV, Lindemans, C & Riches, ML 2016, 'Infection Rates among Acute Leukemia Patients Receiving Alternative Donor Hematopoietic Cell Transplantation', Biology of Blood and Marrow Transplantation, vol. 22, no. 9, pp. 1636-1645. https://doi.org/10.1016/j.bbmt.2016.06.012

Infection Rates among Acute Leukemia Patients Receiving Alternative Donor Hematopoietic Cell Transplantation. / Ballen, Karen; Woo Ahn, Kwang; Chen, Min; Abdel-Azim, Hisham; Ahmed, Ibrahim; Aljurf, Mahmoud; Antin, Joseph; Bhatt, Ami S.; Boeckh, Michael; Chen, George; Dandoy, Christopher; George, Biju; Laughlin, Mary J.; Lazarus, Hillard M.; MacMillan, Margaret L.; Margolis, David A.; Marks, David I.; Norkin, Maxim; Rosenthal, Joseph; Saad, Ayman; Savani, Bipin; Schouten, Harry C.; Storek, Jan; Szabolcs, Paul; Ustun, Celalettin; Verneris, Michael R.; Waller, Edmund K.; Weisdorf, Daniel J.; Williams, Kirsten M.; Wingard, John R.; Wirk, Baldeep; Wolfs, Tom; Young, Jo Anne H.; Auletta, Jeffrey; Komanduri, Krishna V.; Lindemans, Caroline; Riches, Marcie L.

In: Biology of Blood and Marrow Transplantation, Vol. 22, No. 9, 01.09.2016, p. 1636-1645.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Infection Rates among Acute Leukemia Patients Receiving Alternative Donor Hematopoietic Cell Transplantation

AU - Ballen, Karen

AU - Woo Ahn, Kwang

AU - Chen, Min

AU - Abdel-Azim, Hisham

AU - Ahmed, Ibrahim

AU - Aljurf, Mahmoud

AU - Antin, Joseph

AU - Bhatt, Ami S.

AU - Boeckh, Michael

AU - Chen, George

AU - Dandoy, Christopher

AU - George, Biju

AU - Laughlin, Mary J.

AU - Lazarus, Hillard M.

AU - MacMillan, Margaret L.

AU - Margolis, David A.

AU - Marks, David I.

AU - Norkin, Maxim

AU - Rosenthal, Joseph

AU - Saad, Ayman

AU - Savani, Bipin

AU - Schouten, Harry C.

AU - Storek, Jan

AU - Szabolcs, Paul

AU - Ustun, Celalettin

AU - Verneris, Michael R.

AU - Waller, Edmund K.

AU - Weisdorf, Daniel J.

AU - Williams, Kirsten M.

AU - Wingard, John R.

AU - Wirk, Baldeep

AU - Wolfs, Tom

AU - Young, Jo Anne H.

AU - Auletta, Jeffrey

AU - Komanduri, Krishna V.

AU - Lindemans, Caroline

AU - Riches, Marcie L.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84991263492&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84991263492&partnerID=8YFLogxK

U2 - 10.1016/j.bbmt.2016.06.012

DO - 10.1016/j.bbmt.2016.06.012

M3 - Article

C2 - 27343716

AN - SCOPUS:84991263492

VL - 22

SP - 1636

EP - 1645

JO - Biology of Blood and Marrow Transplantation

JF - Biology of Blood and Marrow Transplantation

SN - 1083-8791

IS - 9

ER -