Infections after Transplantation of Bone Marrow or Peripheral Blood Stem Cells from Unrelated Donors

• Type of Material: Article
• Authors: Jo-Anne H. Young, University of Minnesota; Brent R. Logan, Medical College of Wisconsin; Juan Wu, The EMMES Corporation; John R. Wingard, University of Florida; Daniel J. Weisdorf, University of Minnesota; Cathryn Mudrick, The EMMES Corporation; Kristin Knust, The EMMES Corporation; Mary M. Horowitz, Medical College of Wisconsin; Dennis L. Confer, National Marrow Donor Program; Erik R. Dubberke, Washington University; Steven A. Pergam, Fred Hutchinson Cancer Research Center; Francisco M. Marty, Dana-Farber Cancer Institute; Lynne M. Strasfeld, Oregon Health & Science University; Janice (Wes) M. Brown, Stanford University; Amelia Langston, Emory University; Mindy G. Schuster, University of Pennsylvania; Daniel R. Kaul, University of Michigan; Stanley I. Martin, Ohio State University; Claudio Anasetti, H. Lee Moffitt Cancer Center and Research Institute
• Language: English
• Date: 2016-02-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 American Society for Blood and Marrow Transplantation.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.bbmt.2015.09.013
• Title of Journal or Parent Work: Biology of Blood and Marrow Transplantation
• ISSN: 1083-8791
• Volume: 22
• Issue: 2
• Start Page: 359
• End Page: 370
• Grant/Funding Information: This study was supported by a grant from the National Heart, Lung, and Blood Institute and the National Cancer Institute (U10HL069294), by the Office of Naval Research, and by the National Marrow Donor Program
• Keywords: Aspergillosis; Pre-engraftment; IMPACT; Hematology; Infection; VERSUS-HOST-DISEASE; ASPERGILLUS INFECTIONS; Immunology; COMPLICATIONS; CORD BLOOD; MALIGNANCIES; RECIPIENTS; Life Sciences & Biomedicine; Cytomegalovirus; CYTOMEGALOVIRUS; Unrelated donor transplantation; DEPLETION; Science & Technology; Bacteremia; ALLOGENEIC TRANSPLANTATION; Transplantation
• Research Categories: Biology, Cell; Health Sciences, Medicine and Surgery; Health Sciences, Oncology

Abstract

Infection is a major complication of hematopoietic cell transplantation. Prolonged neutropenia and graft-versus-host disease are the 2 major complications with an associated risk for infection, and these complications differ according to the graft source. A phase 3, multicenter, randomized trial (Blood and Marrow Transplant Clinical Trials Network [BMT CTN] 0201) of transplantation of bone marrow (BM) versus peripheral blood stem cells (PBSC) from unrelated donors showed no significant differences in 2-year survival between these graft sources. In an effort to provide data regarding whether BM or PBSC could be used as a preferential graft source for transplantation, we report a detailed analysis of the infectious complications for 2 years after transplantation from the BMT CTN 0201 trial. A total of 499 patients in this study had full audits of infection data. A total of 1347 infection episodes of moderate or greater severity were documented in 384 (77%) patients; 201 of 249 (81%) of the evaluable patients had received a BM graft and 183 of 250 (73%) had received a PBSC graft. Of 1347 infection episodes, 373 were severe and 123 were life-threatening and/or fatal; 710 (53%) of these episodes occurred on the BM arm and 637 (47%) on the PBSC arm, resulting in a 2-year cumulative incidence 84.7% (95% confidence interval [CI], 79.6 to 89.8) for BM versus 79.7% (95% CI, 73.9 to 85.5) for PBSC, P =013. The majority of these episodes, 810 (60%), were due to bacteria, with a 2-year cumulative incidence of 72.1% and 62.9% in BM versus PBSC recipients, respectively (P =003). The cumulative incidence of bloodstream bacterial infections during the first 100 days was 44.8% (95% CI, 38.5 to 51.1) for BM versus 35.0% (95% CI, 28.9 to 41.1) for PBSC (P =027). The total infection density (number of infection events/100 patient days at risk) was.67 for BM and.60 for PBSC. The overall infection density for bacterial infections was.4 in both arms; for viral infections, it was.2 in both arms; and for fungal/parasitic infections, it was.04 and.05 for BM and PBSC, respectively. The cumulative incidence of infection before engraftment was 47.9% (95% CI, 41.5 to 53.9) for BM versus 32.8% (95% CI, 27.1 to 38.7) for PBSC (P =002), possibly related to quicker neutrophil engraftment using PBSC. Infections remain frequent after unrelated donor hematopoietic cell transplantation, particularly after BM grafts.