The impact of graft cell source on bloodstream infection in the first 100 days after allogeneic hematopoietic cell transplantation

Takagi, Shinsuke; Ogura, Sho; Araoka, Hideki; Uchida, Naoyuki; Mitsuki, Takashi; Yuasa, Mitsuhiro; Kageyama, Kosei; Kaji, Daisuke; Taya, Yuki; Nishida, Aya; Kimura, Muneyoshi; Ishiwata, Kiichi; Yamamoto, Hisashi; Yamamoto, Go; Asano‐Mori, Yuki; Koike, Yukako; Izutsu, Koji; Wake, Atsushi; Makino, Shigeyoshi; Yoneyama, Akio; Taniguchi, Satoshi

doi:10.1038/s41409-021-01229-6

Cited by 13 publications

(16 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1 Therefore, this definition of infection might not be truly reflected in carryover infection before HCT. Indeed, given the expected slower neutrophil recovery HCT 26 because of early infectious complications, 27,28 relating to the use of potentially nephrotoxic drugs, and the development of preengraftment syndrome. Pre-engraftment syndrome is a unique clinical manifestation after CBT characterized by noninfectious fever, erythematous skin rash, and body weight gain before neutrophil engraftment.…”

Section: Discussionmentioning

confidence: 99%

“…The exact mechanisms underlying the differential effects of these comorbidities on NRM between unrelated adult donor recipients and UCB recipients remain to be fully elucidated. UCB recipients could have an increased susceptibility to fluid overload during the early phase of HCT 26 because of early infectious complications, 27,28 relating to the use of potentially nephrotoxic drugs, and the development of pre‐engraftment syndrome. Pre‐engraftment syndrome is a unique clinical manifestation after CBT characterized by noninfectious fever, erythematous skin rash, and body weight gain before neutrophil engraftment 29–31 .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Association of individual comorbidities with outcomes in allogeneic hematopoietic cell transplantation from unrelated adult donors versus unrelated cord blood: A study on behalf of the Donor/Source and Transplant Complications Working Groups of the Japanese Society for Transplantation and Cellular Therapy

Konuma,

Harada,

Shinohara

et al. 2024

American J Hematol

Self Cite

View full text Add to dashboard Cite

We retrospectively evaluated the effect of 17 individual comorbidities, defined by the hematopoietic cell transplantation (HCT)‐specific comorbidity index, on non‐relapse mortality (NRM) and overall survival (OS) in 9531 patients aged between 16 and 70 years who underwent their first allogeneic HCT from 8/8 and 7/8 allele‐matched unrelated donors (8/8 and 7/8 MUDs) or single‐unit unrelated cord blood (UCB) between 2011 and 2020 using data from a Japanese registry database. In the multivariate analysis, infection (adjusted hazard ratio [HR], 1.62, 95% confidence interval [CI], 1.33–1.99 for 8/8 and 7/8 MUDs; adjusted HR, 1.33, 95%CI, 1.12–1.58 for UCB) and moderate/severe hepatic comorbidity (adjusted HR, 1.57, 95%CI, 1.04–2.38 for 8/8 and 7/8 MUDs; adjusted HR, 1.53, 95%CI, 1.09–2.15 for UCB) had a significant impact on NRM in both donor groups. Cardiac comorbidity (adjusted HR, 1.40, 95%CI, 1.08–1.80), mild hepatic comorbidity (adjusted HR, 1.22, 95%CI, 1.01–1.48), rheumatologic comorbidity (adjusted HR, 1.67, 95%CI, 1.11–2.51), renal comorbidity (adjusted HR, 2.44, 95%CI, 1.46–4.09), and severe pulmonary comorbidity (adjusted HR, 1.40, 95%CI, 1.11–1.77) were significantly associated with an increased risk of NRM but only in UCB recipients. Renal comorbidity had the strongest impact on poor OS in both donor groups (adjusted HR, 1.73, 95%CI, 1.10–2.72 for 8/8 and 7/8 MUDs; adjusted HR, 2.24, 95%CI, 1.54–3.24 for UCB). Therefore, unrelated donor selection should be taken into consideration along with the presence of specific comorbidities, such as cardiac, rheumatologic, renal, mild hepatic, and severe pulmonary comorbidities.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of individual comorbidities with outcomes in allogeneic hematopoietic cell transplantation from unrelated adult donors versus unrelated cord blood: A study on behalf of the Donor/Source and Transplant Complications Working Groups of the Japanese Society for Transplantation and Cellular Therapy

Konuma,

Harada,

Shinohara

et al. 2024

American J Hematol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Indeed, along with the use of UCB, the occurrence of acute GVHD, infections, and acute kidney injury (AKI) were significant predictors of longer hospital length of stay 31 . Some of these posttransplant complications, such as infections and AKI, were increased by the use of UCB 33–35 . Moreover, extended hospitalization following CBT may result in higher room‐and‐board expenses, greater consumption of pharmaceutical and laboratory utilities, and higher blood component prices, resulting in larger absolute costs for UCB transplantation during the first 100 days compared to MSD transplantation 32 .…”

Section: Discussionmentioning

confidence: 99%

“…31 Some of these posttransplant complications, such as infections and AKI, were increased by the use of UCB. [33][34][35] Moreover, extended hospitalization following CBT may result in higher room-and-board expenses, greater consumption of pharmaceutical and laboratory utilities, and higher blood component prices, resulting in larger absolute costs for UCB transplantation during the first 100 days compared to MSD transplantation. 32 All these findings could contribute to the greater cost of CBT in the early phase of HCT.…”

Section: Grades Ii-iv Acute Gvhd Grades Iii-iv Acute Gvhdmentioning

confidence: 99%

Single‐unit unrelated cord blood transplantation versus HLA‐matched sibling transplantation in adults with advanced myelodysplastic syndrome: A registry‐based study from the adult MDS working group of the Japanese society for transplantation and cellular therapy

Konuma,

Itonaga,

Shimomura

et al. 2023

Hematological Oncology

Self Cite

View full text Add to dashboard Cite

Allogeneic hematopoietic stem cell transplantation (HCT) remains the only potential curative therapeutic modality for advanced myelodysplastic syndrome (MDS). Within HCT, the advancement of cord blood transplantation (CBT) procedures has resulted in a drastic expansion of CBT as a donor source for MDS. However, data comparing matched sibling donors (MSDs) HCT with CBT for advanced MDS, which was defined as refractory anemia with an excess of blasts (RAEB)‐1 and RAEB‐2 according to the World Health Organization classification at the time of HCT, have not been explored. We retrospectively compared survival and other posttransplant outcomes in 999 adult patients with advanced MDS after receiving allogeneic HCT in Japan between 2011 and 2020, using either MSD (n = 331) or single‐unit unrelated cord blood (UCB) (n = 668). In the multivariate analysis, there were no significant differences in overall survival (hazard ratio [HR], 1.10; 95% confidence interval [CI], 0.90–1.34; P = 0.347), disease‐free survival (HR, 1.01; 95% CI, 0.84–1.23; P = 0.845), relapse (HR, 0.88; 95% CI, 0.68–1.15; P = 0.370), or non‐relapse mortality (HR, 1.15; 95% CI, 0.87–1.50; P = 0.310) between MSD recipients and UCB recipients. UCB was significantly associated with lower neutrophil (HR, 0.28; 95% CI, 0.24–0.33; P < 0.001) and lower platelet (HR, 0.29; 95% CI, 0.23–0.36; P < 0.001) recovery compared to MSD. UCB was significantly associated with a lower incidence of chronic graft‐versus‐host disease (GVHD) (HR, 0.57; 95% CI, 0.44–0.75; P < 0.001) and extensive chronic GVHD (HR, 0.46; 95% CI, 0.32–0.67; P < 0.001) compared to MSD. Similar results were observed after adjusting for differences between MSD and UCB recipients by propensity score matching analysis. Our study demonstrated that single CBT and MSD HCT had similar survival outcomes for adult patients with advanced MDS despite the lower hematopoietic recovery in CBT recipients and higher chronic GVHD in MSD recipients.

show abstract

“…1,16,18 This may be related to our clinical anti-infective prevention strategy. 19 Previous studies have reported that the occurrence of BSIs in HSCT patients is associated with specific risk factors including severe GVHD, 15,20 allogeneic HSCT, 21,22 unrelated HSCT donors, 23,24 intestinal colonization 25 and myeloablative therapy. 26 In our study, male, not in complete remission at transplantation and longer duration of neutropenia were risk factors for the development of BSI after HSCT.…”

Section: Discussionmentioning

confidence: 99%

Microbiology and Clinical Outcome of Bloodstream Infections in Patients After Hematopoietic Stem Cell Transplantation

Song,

Zhu

et al. 2023

IDR

View full text Add to dashboard Cite

Patients after hematopoietic stem cell transplantation (HSCT) are often followed by bloodstream infections (BSIs). BSI is an important cause of non-relapse mortality (NRM) in HSCT patients. Methods: We conducted a retrospective cohort study of patients (aged >14 years) who underwent HSCT at our hospital from 2017 to 2021. Population characteristics, BSI microbiology, resistance to common antibiotics, and 30-day all-cause mortality were analyzed. Results: Of 3054 patients, 169 (5.5%) had BSIs after HSCT. Male, not in complete remission at transplantation and longer duration of neutropenia were risk factors for the development of BSI after HSCT. These BSIs were Gram-negative bacterial (n=123, 69.49%), Gram-positive bacterial (n=27, 15.25%), fungal (n=11, 6.36%), and polymicrobial (n=16, 9.25%). Among the Gram-negative bacteria, the proportions of isolates resistant to ceftazidime, cefepime, and piperacillin-tazobactam were similar (72.93%, 74.80%, and 77.42%, respectively). The overall drug resistance rates of amikacin and imipenem were 16.13% and 43.90%, respectively. Staphylococcus isolates were methicillin-resistant. In Enterococcus isolates, the penicillin resistance rate was 84.62%. Eleven isolates of Candida tropicalis were resistant to fluconazole and were sensitive to amphotericin B and flucytosine. The 30-day all-cause mortality rate of the 169 patients with BSIs was 8.88%. The 30-day all-cause mortality of patients with Gram-negative bacterial BSIs was 7.32%, 25.00% for polymicrobial BSIs, and 36.36% for fungal BSIs. The 30-day all-cause mortality of patients with fungal BSIs was significantly higher than that of patients with Gram-negative (P=0.0023) and Gram-positive bacteria (P=0.0023). Fungal BSI and non-Hodgkin's lymphoma (NHL) were associated with higher 30-day mortality. Conclusion: Our study reveals the microbiological characteristics and 30-day all-cause mortality in patients with bloodstream infections after HSCT. Our data provides strong support for empirical antimicrobial therapy and infection prevention strategies for patients with BSIs after HSCT.

show abstract

The impact of graft cell source on bloodstream infection in the first 100 days after allogeneic hematopoietic cell transplantation

Cited by 13 publications

References 36 publications

Single‐unit unrelated cord blood transplantation versus HLA‐matched sibling transplantation in adults with advanced myelodysplastic syndrome: A registry‐based study from the adult MDS working group of the Japanese society for transplantation and cellular therapy

Microbiology and Clinical Outcome of Bloodstream Infections in Patients After Hematopoietic Stem Cell Transplantation

Contact Info

Product

Resources

About