Microbiologically documented infections after adult allogeneic hematopoietic cell transplantation: A 5‐year analysis within the Swiss Transplant Cohort study

Abstract

Background Infections are an important complication after allogeneic hematopoietic cell transplantation (allo‐HCT). The present study aimed at determining the landscape of infections occurring in a large cohort of allo‐HCT patients, as well as associated risk factors for infections and for one‐year non‐relapse mortality. Methods This is a retrospective cohort study using STCS and EBMT databases to assess the one‐year incidence rate of infection, as well as risk factors for infections and for one‐year non‐relapse mortality among adult allo‐HCT patients transplanted between 2010 and 2014 in Switzerland. Univariable and multivariable quasi‐Poisson and multivariable Cox regression models were used. Results Of 553 patients included, 486 had an infection with a global incidence rate of 3.66 infections per patient‐year. Among a total of 1534 infections analyzed, viral infections were predominant (n = 1138, 74.2%), followed by bacterial (n = 343, 22.4%) and fungal (n = 53, 3.5%) infections. At one year, the cumulative incidence of relapse and non‐relapse mortality was 26% and 16%, respectively. 195 (35.3%) of patients had at least one episode of severe graft‐versus‐host‐disease (GvHD). A center effect was observed, and underlying disease, donor type, cytomegalovirus serological constellation, and GvHD were also associated with the incidence rate of infections. There was an increased risk for one‐year non‐relapse mortality associated with all pathogens, specifically within two months of infection, and this remained true beyond 2 months of a fungal infection. Conclusion Despite advances to limit infections in this population, they still occur in most allo‐HCT patients with a major impact on survival at 1 year.

Unmasking viral sequences by metagenomic next-generation sequencing in adult human blood samples during steroid-refractory/dependent graft-versus-host disease

“…Sequences were considered clinically recognized viruses if they corresponded to a virus known to reactivate in/be frequently found among allo-HSCT recipients [2,4] or if the patient had a known chronic viral infection and clinically unrecognized viruses if not.…”

“…1 Division of Infectious Diseases, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211, 14 Geneva, Switzerland. 2 Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211, 14 Geneva, Switzerland. 3 University of Geneva Medical School, Geneva, Switzerland.…”

“…Viral primary infections and reactivations are common complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and are associated with significant morbidity and mortality [1,2]. Current routine clinical surveillance molecular assays detect specific nucleotide sequences targeting usual culprits including Epstein-Barr virus (EBV), cytomegalovirus (CMV), BK polyomavirus (BKPyV), and adenovirus [3].…”

Beyond Cytomegalovirus and Epstein-Barr Virus: a Review of Viruses Composing the Blood Virome of Solid Organ Transplant and Hematopoietic Stem Cell Transplant Recipients

“…From a general perspective, infectious complications are one of the most common complications after transplantation and are associated with significant morbidity and mortality (25,411,412). Among allo-HSCT recipients, a large Swiss multicenter study reported that viral infections were the most common infections after allo-HSCT, representing 74.2% of all infectious complications, followed by bacterial (22.4%) and fungal (3.5%) infections (411).…”

“…From a general perspective, infectious complications are one of the most common complications after transplantation and are associated with significant morbidity and mortality (25,411,412). Among allo-HSCT recipients, a large Swiss multicenter study reported that viral infections were the most common infections after allo-HSCT, representing 74.2% of all infectious complications, followed by bacterial (22.4%) and fungal (3.5%) infections (411). In this study, the underlying disease, donor type, CMV serological constellation, and GvHD were associated with the incidence rate of infections; furthermore, there was an increased risk for 1-year nonrelapse mortality associated with all pathogens (411).…”