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Author Notes:

Corresponding author: Jo-Anne H. Young, MD. Address: MMC 250, 420 Delaware St SE, Minneapolis, MN 55455. Email: vanbu004@umn.edu. Phone: (612) 625-8462. Fax: (612) 625-4410

J.H.Y. and D.J.W. designed the infectious disease analysis for this study protocol and wrote the paper; C.A., J.R.W., M.M.H. and D.J.W. were senior advisors in the design, conduct, and analysis of the study; K.K. and C.M. organized and maintained the database, J.H.Y., J.R.W, E.R.D., S.A.P., F.M.M. L.M.S., J.M.B., A.A.L., M.G.S., D.R.K., and S.I.M. audited many infection summaries; J.W. and J.H.Y. analyzed data; B.R.L., and J.W. provided statistical analysis; all authors reviewed and provided insightful comments to better the manuscript; and J.W. and J.H.Y. drew the figures.

The authors thank the transplantation center teams in the United States and Canada for enrolling patients in this trial; the donor-center teams in the United States, Canada, and Germany for recruiting the donors for the trial; and the National Marrow Donor Program coordinating center for facilitating the transplantations.

For full list of acknowledgements see full article.

The authors declare no competing financial interests.

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Research Funding:

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:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Hematology
  • Immunology
  • Transplantation
  • Infection
  • Unrelated donor transplantation
  • Bacteremia
  • Cytomegalovirus
  • Aspergillosis
  • Pre-engraftment
  • VERSUS-HOST-DISEASE
  • ALLOGENEIC TRANSPLANTATION
  • ASPERGILLUS INFECTIONS
  • CORD BLOOD
  • CYTOMEGALOVIRUS
  • RECIPIENTS
  • IMPACT
  • COMPLICATIONS
  • MALIGNANCIES
  • DEPLETION

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

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Journal Title:

Biology of Blood and Marrow Transplantation

Volume:

Volume 22, Number 2

Publisher:

, Pages 359-370

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

© 2016 American Society for Blood and Marrow Transplantation.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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