Incidence of viral and fungal complications after utilization of alternative donor sources in hematopoietic cell transplantation

Abstract

Allogeneic hematopoietic cell transplantation (HCT) remains the only curable option for adult patients with hematologic malignancies. According to guidelines published by the American Society for Transplantation and Cellular Therapy, allogeneic HCT should be offered to all intermediate‐ and high‐risk patients with acute leukemia. While matched‐related donor (MRD) grafts continue to be the preferred stem cell source for allogeneic HCT, studies comparing MRD grafts to matched‐unrelated donor (MUD) grafts showed comparable outcomes in patients with acute leukemia. Unfortunately, for those without a suitable matched‐related graft, the probability of finding a suitable matched‐unrelated donor varies significantly depending on racial and ethnic background. With allogeneic HCT procedures increasing year after year due to the increased availability of suitable donors, each of these alternative donor sources merits special clinical considerations, specifically with regard to infections. Infections remain a significant cause of morbidity and mortality after allogeneic transplant, especially in those receiving alternative donor grafts. Due to the high‐risk nature associated with these donor grafts, it is important to understand the true risk of developing infectious complications. While there are a multitude of infections that have been described in patients post‐allogeneic HCT, this review seeks to focus on the incidence of cytomegalovirus (CMV) and invasive fungal infections (IFI) in adult patients receiving alternative donor source transplantation for hematologic malignancies.

Pre-Transplant Platelet Refractoriness and Alternative Donors Are Associated With Cytomegalovirus Retinitis in Hematopoietic Stem Cell Transplantation for Severe Aplastic Anemia

“…For those without a suitable matched sibling donor, the availability of alternative donors has become the immediate next best option. However, there have been some reports on the particular risk of HSCT-related CMV infection among recipients of alternative grafts ( Whited et al, 2020 ; Cho et al., 2021 ). We previously also demonstrated the high risk of CMVR associated with HLA-mismatched donors in a retrospective study based on SAA and malignant hematological diseases ( Zhang et al, 2017 ).…”

Cidofovir, a choice for salvage treatment of cytomegalovirus infection in patients with haploidentical hematopoietic stem cell transplantation

“…In haplo-HSCT patients, ATG administration and high incidence of grade II-IV aGVHD would lead to more severe CMV infection (higher occurrence and progress to CMV disease, and being refractory to current preemptive antiviral therapy) due to depressing the immune system and delaying the immune reconstitution when compared with other allo-HSCT patients. 3,5,21,22 However, current conventional preemptive antiviral therapy with GCV or FSC displayed limited efficacy and predictable side effects. 7,9 Several novel agents have emerged, while they are still on the road and rarely applied in the clinic.…”