Fewer infections and lower infection-related mortality following non-myeloablative versus myeloablative conditioning for allotransplantation of patients with lymphoma

Abstract

Non-myeloablative (NMA) allogeneic donor SCT for patients with relapsed lymphoma is associated with lower treatment-related mortality (TRM). However, the impact of conditioning intensity on post transplant infections remains unclear. We evaluated infections in 141 consecutive patients with lymphoma who were allografted using NMA (n ¼ 76) or myeloablative (MA; n ¼ 65) conditioning regimens. Using infection incidence density per 1000 patient days, we accounted for all infectious episodes during the first post transplant year. Before neutrophil engraftment, the NMA cohort had a 53% lower rate of bacterial infection (relative risk ¼ 0.47; P ¼ 0.06), whereas after engraftment the density of bacterial infections was similar in the two groups. In the first month, both invasive fungal infections and viral infections were twofold less frequent (P ¼ 0.22; P ¼ 0.06) in NMA patients. Late viral and fungal infections as well as CMV reactivation were infrequent after either conditioning intensity. The 1-year infection-related mortality was significantly lower after NMA conditioning (NMA 9% (3-16%) vs MA 22% (11-40%); P ¼ 0.03). NMA allogeneic transplantation for lymphoma patients results in substantially fewer early infections and lower infection-related deaths, although the similar frequency of later infections suggests that immune reconstitution is delayed with either conditioning intensity.

Mucosal barrier injury, fever and infection in neutropenic patients with cancer: introducing the paradigm febrile mucositis

“…Similarly, the use of recombinant human IL11 preserved the gut barrier after cytotoxic therapy and resulted in a decrease in bacteraemia (Ellis et al, 2003). Comparable results have been shown with the use of less mucotoxic therapies, such as the socalled reduced-intensity conditioning regimens, which result in fewer days of fever and less gram-positive coccal bacteraemia (Bachanova et al, 2009). The association between chemotherapy-induced MBI of the gut and the occurrence of acute GVHD, which frequently involves the gut, is compelling (Goldberg et al, 2005).…”

Pre-existing invasive fungal infection is not a contraindication for allogeneic HSCT for patients with hematologic malignancies: a CIBMTR study

“…Likewise, use of granulocyte colony-stimulating growth factors has decreased the length of neutropenia, a major risk factor for IFI 2– 7 . Additionally, reduced intensity conditioning (RIC) transplantation may help to minimize opportunistic infections and to maximize graft-versus-tumor effects 8, 9 . These advances in HSCT and its associated supportive care have enabled patients to successfully receive a HSCT despite having previously documented fungal infection 8, 10–12 …”

High Incidence of Herpes Zoster in Nonmyeloablative Hematopoietic Stem Cell Transplantation

“…Indeed, the proportion of NMA HSCT performed in Europe has markedly risen from less that 1% of all allogeneic transplantations before 2000 to 36% in 2007 [10, 11]. Of note, some authors have even suggested that immune recovery could be enhanced after NMA HSCT [12], resulting in lower incidence of infectious complications and decreased infection-related mortality [13, 14]. However, available studies involving NMA regimens provide insufficient data regarding HZ; they include small cohorts, heterogeneous donor/recipient populations, and different NMA protocols, thus limiting the ability to derive robust clinical guidelines.…”