Infections after Allogenic Transplant with Post-Transplant Cyclophosphamide: Impact of Donor HLA Matching

Chiara Oltolini, Raffaella Greco, Laura Galli, Daniela Clerici, Francesca Lorentino, Elisabetta Xue, Maria Teresa Lupo Stanghellini, Fabio Giglio, Lina Uhr, Marco Ripa, Paolo Scarpellini, Massimo Bernardi, Consuelo Corti, Jacopo Peccatori, Antonella Castagna, Fabio Ciceri

Research output: Contribution to journalArticlepeer-review

Abstract

Incidence and outcome of infections after allogeneic hematopoietic stem cell transplantation (HSCT) with post-transplant cyclophosphamide (PT-Cy) as graft-versus-host disease (GVHD) prophylaxis are largely unknown. Study aims were to estimate the incidence of pre-engraftment bloodstream infections (PE-BSIs) and viral infections (VIs; cytomegalovirus [CMV], adenovirus [ADV], human herpes virus 6 [HHV6], and BK-polyomavirus hemorrhagic-cystitis [BKPyV-HC]), their predictive factors, and infection-related mortality (IRM) after HSCT with PT-Cy. We analyzed 235 patients: 62%, 21%, and 17% received haploidentical (haplo), matched-unrelated donor (MUD), and matched-related donor, respectively. Overall, 72 patients had 77 PE-BSI episodes at a median time of 13 days after HSCT: cumulative incidence function (CIF) at 28 days was 32%, without differences among donor types (P = .988). By multivariate analysis, CIF of PE-BSI was higher in patients with severe neutropenia before HSCT (adjusted hazard ratio [AHR] = 2.90) and in multidrug-resistant Gram-negative bacteria rectal carriers (AHR = 2.68). IRM at 30 days was 5%, without differences by donor type (P = .106). Overall, 208 patients experienced ≥1 VIs (first occurrence among CMV, HHV6, ADV, BKPyV-HC) at a median time of 20 days after HSCT: CIF at 90 days was 91%, significantly higher in MUD and haplo (P = .0089). By multivariate analysis, also acute GVHD grade ≥2 (AHR = 1.32) and host/donor CMV-serology mismatch (positive/positive versus negative/negative: AHR = 2.95, positive/negative versus negative/negative: AHR = 2.41, negative/positive versus negative/negative: AHR = 2.35) affected VIs occurrence. IRM at 180 days was 8%, without differences among donor types (P = .106). In conclusion, study results did not show a significant impact of donor type on PE-BSI incidence; conversely, MUD and haploidentical transplants retained a higher occurrence of VIs in the early phase after HSCT.

Original languageEnglish
Pages (from-to)1179-1188
Number of pages10
JournalBiology of Blood and Marrow Transplantation
Volume26
Issue number6
DOIs
Publication statusPublished - Jun 2020

Keywords

  • Allogeneic hematopoietic stem cell transplantation
  • Infections
  • Post-transplant cyclophosphamide
  • Pre-engraftment bloodstream infections
  • Viral infections

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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