Prognostic Factors for Mortality among Day +100 Survivors after Allogeneic Hematopoietic Cell Transplantation

Abstract

Although day +100 survival among allogeneic hematopoietic cell transplantation (HCT) recipients has improved over time, longer-term survival remains a challenge. The aim of this study was to identify prognostic factors for survival among patients surviving longer than 100 days using baseline characteristics and factors identified within the first 100 days after transplantation. Of 413 patients undergoing a first allogeneic HCT between 2006 and 2014, 335 survived >100 days post-transplantation. The majority underwent a myeloablative transplantation (75%) with a bone marrow (BM) (52%) graft source. One-year all-cause mortality (ACM) was 29%, with 16% relapse mortality (RM) and 12% nonrelapse mortality. In multivariable analysis, high-risk disease (hazard ratio [HR], 1.55; P = .003), non-cytomegalovirus infection (HR, 1.79; P = .003), more days hospitalized (HR, 1.16; P < .001), and relapse (HR, 4.38; P < .001) within the first 100 days were associated with increased risk of ACM. Patients with higher income (HR, .89; P = .024) and those who received BM (HR, .52; P < .001) or umbilical cord blood (HR, .40; P = .002) relative to peripheral blood stem cells had lower risk of ACM. Our study identifies risk factors for adverse long-term survival in 100-day survivors, a time point when patients frequently are discharged from transplantation centers. In addition to disease- and transplantation-related factors, low socioeconomic status was associated with worse long-term survival, highlighting the need for focused efforts to improve outcomes in vulnerable patient populations.

Oral Vancomycin Prophylaxis Is Highly Effective in Preventing Clostridium difficile Infection in Allogeneic Hematopoietic Cell Transplant Recipients

“…Metronidazole days, median (IQR) ---1.5 (1,2) Abbreviations: IQR, interquartile range. a Gram-negative antibiotics included cefepime, piperacillin/tazobactam, meropenem, ceftazidime, aztreonam, and levofloxacin.…”

“…Infection remains a major cause of morbidity and mortality following alloHCT [1]. Among the most common infectious complications is Clostridium difficile infection (CDI), which occurs in up to 33% of alloHCT recipients and has been identified as an independent risk factor for increased mortality [2,3].…”

Allogeneic Hematopoietic Cell Transplantation in the Outpatient Setting

“…A recent study at the Cleveland Clinic, which examined identifying prognostic factors for survival within the first 100 days after transplantation, reported a 44% first readmission rate and 2-year NRM of 16%. Patel et al [26] found acute GVHD or more hospitalization days within the first 100 days prognostic for increased NRM. We confirmed some of these prognostic factors, although in their retrospective study, the majority of the 413 patients underwent myeloablative allogeneic HCT with marrow as graft source.…”

Secular trends of Blood stream infections in allogeneic hematopoietic cell transplant recipients 72 hours prior to death

“…Our institutional conditioning and GVHD prophylaxis regimens have been described previously. [18][19][20][21]…”