Pre-Engraftment Bloodstream Infections after Allogeneic Hematopoietic Cell Transplantation: Impact of T Cell-Replete Transplantation from a Haploidentical Donor

Malgorzata Mikulska, Anna Maria Raiola, Federica Galaverna, Elisa Balletto, Maria Lucia Borghesi, Riccardo Varaldo, Francesca Gualandi, Livia Giannoni, Giordana Pastori, Daniele Roberto Giacobbe, Alessio Signori, Valerio Del Bono, Claudio Viscoli, Andrea Bacigalupo, Emanuele Angelucci

Research output: Contribution to journalArticle

Abstract

Bloodstream infections (BSIs) are frequent and important infectious complications after hematopoietic cell transplantation (HCT). The aim of this study was to analyze the incidence, risk factors, and outcome of pre-engraftment BSIs after allogeneic HCT. We retrospectively analyzed data from 553 consecutive patients who underwent HCT between 2010 and 2016. Sixty percent of the patients received T cell-replete unmanipulated haploidentical bone marrow with high-dose post-transplantation cyclophosphamide. The BSI rate was 30%; among isolated 213 pathogens, 54% were Gram-positive, 43% were Gram-negative, and 3% were fungi. Independent risk factors for pre-engraftment BSI were transplantation from a haploidentical donor or from cord blood (P < .001), active disease (P = .002), age (P = .04), and myeloproliferative disorders or aplastic anemia (P < .001). Transplantation from a haploidentical donor was an independent risk factor for both Gram-positive and Gram-negative BSI. The 7-day mortality after any BSI was 5% (9 of 178), and in multivariate analysis, BSI etiology was the sole risk factor, with increased mortality in carbapenem-resistant Gram-negative BSI (P < .001). Nonrelapse mortality at day +60 after HCT was 3.8% (21 of 553); independent predictors were active disease (P = .045), year of HCT (P = .027), nonengraftment (P = .001), and pre-engraftment BSI (P < .001), with significantly higher risk in BSI due to Gram-negative pathogens compared with Gram-positive pathogens, and BSI due to carbapenem-resistant Gram-negative pathogens compared with susceptible pathogens. Pre-engraftment BSI is a frequent complication after HCT from a haploidentical donor or cord blood. Because the negative impact of pre-engraftment BSI on 60-day nonrelapse mortality was caused mainly by carbapenem-resistant Gram-negative pathogens, particular attention should be given to appropriate empiric therapy and management of patients at high risk for Gram-negative BSI.

Original languageEnglish
Pages (from-to)109-118
Number of pages10
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number1
DOIs
Publication statusPublished - Jan 2018

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Cell Transplantation
Tissue Donors
T-Lymphocytes
Infection
Carbapenems
Mortality
Transplantation
Fetal Blood
Myeloproliferative Disorders
Aplastic Anemia
Cyclophosphamide
Fungi
Multivariate Analysis

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Pre-Engraftment Bloodstream Infections after Allogeneic Hematopoietic Cell Transplantation : Impact of T Cell-Replete Transplantation from a Haploidentical Donor. / Mikulska, Malgorzata; Raiola, Anna Maria; Galaverna, Federica; Balletto, Elisa; Borghesi, Maria Lucia; Varaldo, Riccardo; Gualandi, Francesca; Giannoni, Livia; Pastori, Giordana; Giacobbe, Daniele Roberto; Signori, Alessio; Del Bono, Valerio; Viscoli, Claudio; Bacigalupo, Andrea; Angelucci, Emanuele.

In: Biology of Blood and Marrow Transplantation, Vol. 24, No. 1, 01.2018, p. 109-118.

Research output: Contribution to journalArticle

Mikulska, M, Raiola, AM, Galaverna, F, Balletto, E, Borghesi, ML, Varaldo, R, Gualandi, F, Giannoni, L, Pastori, G, Giacobbe, DR, Signori, A, Del Bono, V, Viscoli, C, Bacigalupo, A & Angelucci, E 2018, 'Pre-Engraftment Bloodstream Infections after Allogeneic Hematopoietic Cell Transplantation: Impact of T Cell-Replete Transplantation from a Haploidentical Donor', Biology of Blood and Marrow Transplantation, vol. 24, no. 1, pp. 109-118. https://doi.org/10.1016/j.bbmt.2017.08.024
Mikulska, Malgorzata ; Raiola, Anna Maria ; Galaverna, Federica ; Balletto, Elisa ; Borghesi, Maria Lucia ; Varaldo, Riccardo ; Gualandi, Francesca ; Giannoni, Livia ; Pastori, Giordana ; Giacobbe, Daniele Roberto ; Signori, Alessio ; Del Bono, Valerio ; Viscoli, Claudio ; Bacigalupo, Andrea ; Angelucci, Emanuele. / Pre-Engraftment Bloodstream Infections after Allogeneic Hematopoietic Cell Transplantation : Impact of T Cell-Replete Transplantation from a Haploidentical Donor. In: Biology of Blood and Marrow Transplantation. 2018 ; Vol. 24, No. 1. pp. 109-118.
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T1 - Pre-Engraftment Bloodstream Infections after Allogeneic Hematopoietic Cell Transplantation

T2 - Impact of T Cell-Replete Transplantation from a Haploidentical Donor

AU - Mikulska, Malgorzata

AU - Raiola, Anna Maria

AU - Galaverna, Federica

AU - Balletto, Elisa

AU - Borghesi, Maria Lucia

AU - Varaldo, Riccardo

AU - Gualandi, Francesca

AU - Giannoni, Livia

AU - Pastori, Giordana

AU - Giacobbe, Daniele Roberto

AU - Signori, Alessio

AU - Del Bono, Valerio

AU - Viscoli, Claudio

AU - Bacigalupo, Andrea

AU - Angelucci, Emanuele

N1 - Copyright © 2018. Published by Elsevier Inc.

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N2 - Bloodstream infections (BSIs) are frequent and important infectious complications after hematopoietic cell transplantation (HCT). The aim of this study was to analyze the incidence, risk factors, and outcome of pre-engraftment BSIs after allogeneic HCT. We retrospectively analyzed data from 553 consecutive patients who underwent HCT between 2010 and 2016. Sixty percent of the patients received T cell-replete unmanipulated haploidentical bone marrow with high-dose post-transplantation cyclophosphamide. The BSI rate was 30%; among isolated 213 pathogens, 54% were Gram-positive, 43% were Gram-negative, and 3% were fungi. Independent risk factors for pre-engraftment BSI were transplantation from a haploidentical donor or from cord blood (P < .001), active disease (P = .002), age (P = .04), and myeloproliferative disorders or aplastic anemia (P < .001). Transplantation from a haploidentical donor was an independent risk factor for both Gram-positive and Gram-negative BSI. The 7-day mortality after any BSI was 5% (9 of 178), and in multivariate analysis, BSI etiology was the sole risk factor, with increased mortality in carbapenem-resistant Gram-negative BSI (P < .001). Nonrelapse mortality at day +60 after HCT was 3.8% (21 of 553); independent predictors were active disease (P = .045), year of HCT (P = .027), nonengraftment (P = .001), and pre-engraftment BSI (P < .001), with significantly higher risk in BSI due to Gram-negative pathogens compared with Gram-positive pathogens, and BSI due to carbapenem-resistant Gram-negative pathogens compared with susceptible pathogens. Pre-engraftment BSI is a frequent complication after HCT from a haploidentical donor or cord blood. Because the negative impact of pre-engraftment BSI on 60-day nonrelapse mortality was caused mainly by carbapenem-resistant Gram-negative pathogens, particular attention should be given to appropriate empiric therapy and management of patients at high risk for Gram-negative BSI.

AB - Bloodstream infections (BSIs) are frequent and important infectious complications after hematopoietic cell transplantation (HCT). The aim of this study was to analyze the incidence, risk factors, and outcome of pre-engraftment BSIs after allogeneic HCT. We retrospectively analyzed data from 553 consecutive patients who underwent HCT between 2010 and 2016. Sixty percent of the patients received T cell-replete unmanipulated haploidentical bone marrow with high-dose post-transplantation cyclophosphamide. The BSI rate was 30%; among isolated 213 pathogens, 54% were Gram-positive, 43% were Gram-negative, and 3% were fungi. Independent risk factors for pre-engraftment BSI were transplantation from a haploidentical donor or from cord blood (P < .001), active disease (P = .002), age (P = .04), and myeloproliferative disorders or aplastic anemia (P < .001). Transplantation from a haploidentical donor was an independent risk factor for both Gram-positive and Gram-negative BSI. The 7-day mortality after any BSI was 5% (9 of 178), and in multivariate analysis, BSI etiology was the sole risk factor, with increased mortality in carbapenem-resistant Gram-negative BSI (P < .001). Nonrelapse mortality at day +60 after HCT was 3.8% (21 of 553); independent predictors were active disease (P = .045), year of HCT (P = .027), nonengraftment (P = .001), and pre-engraftment BSI (P < .001), with significantly higher risk in BSI due to Gram-negative pathogens compared with Gram-positive pathogens, and BSI due to carbapenem-resistant Gram-negative pathogens compared with susceptible pathogens. Pre-engraftment BSI is a frequent complication after HCT from a haploidentical donor or cord blood. Because the negative impact of pre-engraftment BSI on 60-day nonrelapse mortality was caused mainly by carbapenem-resistant Gram-negative pathogens, particular attention should be given to appropriate empiric therapy and management of patients at high risk for Gram-negative BSI.

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