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. 2016 Sep;22(9):1636-1645.
doi: 10.1016/j.bbmt.2016.06.012. Epub 2016 Jun 22.

Infection Rates among Acute Leukemia Patients Receiving Alternative Donor Hematopoietic Cell Transplantation

Karen Ballen  1 , Kwang Woo Ahn  2 , Min Chen  3 , Hisham Abdel-Azim  4 , Ibrahim Ahmed  5 , Mahmoud Aljurf  6 , Joseph Antin  7 , Ami S Bhatt  8 , Michael Boeckh  9 , George Chen  10 , Christopher Dandoy  11 , Biju George  12 , Mary J Laughlin  13 , Hillard M Lazarus  14 , Margaret L MacMillan  15 , David A Margolis  16 , David I Marks  17 , Maxim Norkin  18 , Joseph Rosenthal  19 , Ayman Saad  20 , Bipin Savani  21 , Harry C Schouten  22 , Jan Storek  23 , Paul Szabolcs  24 , Celalettin Ustun  25 , Michael R Verneris  15 , Edmund K Waller  26 , Daniel J Weisdorf  25 , Kirsten M Williams  27 , John R Wingard  18 , Baldeep Wirk  28 , Tom Wolfs  29 , Jo-Anne H Young  15 , Jeffrey Auletta  30 , Krishna V Komanduri  31 , Caroline Lindemans  32 , Marcie L Riches  33
Affiliations

Infection Rates among Acute Leukemia Patients Receiving Alternative Donor Hematopoietic Cell Transplantation

Karen Ballen et al. Biol Blood Marrow Transplant. 2016 Sep.

Abstract

Alternative graft sources (umbilical cord blood [UCB], matched unrelated donors [MUD], or mismatched unrelated donors [MMUD]) enable patients without a matched sibling donor to receive potentially curative hematopoietic cell transplantation (HCT). Retrospective studies demonstrate comparable outcomes among different graft sources. However, the risk and types of infections have not been compared among graft sources. Such information may influence the choice of a particular graft source. We compared the incidence of bacterial, viral, and fungal infections in 1781 adults with acute leukemia who received alternative donor HCT (UCB, n= 568; MUD, n = 930; MMUD, n = 283) between 2008 and 2011. The incidences of bacterial infection at 1 year were 72%, 59%, and 65% (P < .0001) for UCB, MUD, and MMUD, respectively. Incidences of viral infection at 1 year were 68%, 45%, and 53% (P < .0001) for UCB, MUD, and MMUD, respectively. In multivariable analysis, bacterial, fungal, and viral infections were more common after either UCB or MMUD than after MUD (P < .0001). Bacterial and viral but not fungal infections were more common after UCB than MMUD (P = .0009 and <.0001, respectively). The presence of viral infection was not associated with an increased mortality. Overall survival (OS) was comparable among UCB and MMUD patients with Karnofsky performance status (KPS) ≥ 90% but was inferior for UCB for patients with KPS < 90%. Bacterial and fungal infections were associated with poorer OS. Future strategies focusing on infection prevention and treatment are indicated to improve HCT outcomes.

Keywords: Infection; Leukemia; Umbilical cord blood.

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Conflict of interest statement

DISCLOSURES Conflict of Interest: The authors report no conflict of interest

Figures

Figure 1
Figure 1
Infection density for specific viral (A), bacterial (B), and fungal (C) infections by graft source
Figure 2
Figure 2
Univariate curves for leukemia free survival by graft source for patients based on Karnofsky score ≥ 90% (A) and <90% (B).
Figure 3
Figure 3
Univariate curves for Overall Survival by graft source for patients based on Karnofsky score ≥ 90% (A) and <90% (B).
See this image and copyright information in PMC

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