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. 2023 Nov 16;10(12):ofad578.
doi: 10.1093/ofid/ofad578. eCollection 2023 Dec.

Routine Infectious Disease Consultation Prior to an Allogeneic Hematopoietic Cell Transplant

Vera Portillo  1 , Stavroula Masouridi-Levrat  2 , Yves Chalandon  2 , Maria Mappoura  2 , Sarah Morin  2 , Annalisa Marinosci  1 , Federica Giannotti  2 , Anne-Claire Mamez  2 , Christian van Delden  1 , Dionysios Neofytos  1
Affiliations

Routine Infectious Disease Consultation Prior to an Allogeneic Hematopoietic Cell Transplant

Vera Portillo et al. Open Forum Infect Dis. .

Abstract

Background: A transplant infectious disease (TID) assessment is essential to select recipients for an allogeneic hematopoietic cell transplant (HCT) and tailor prophylactic and empirical treatment recommendations.

Methods: We performed a retrospective single-center study to describe our model of care based on a routine TID consultation prior to an allogeneic HCT between 2018 and 2022 in 292 adult (≥18-year-old) consecutive patients. We describe the performance of a TID consultation, arbitrarily defined as major (HCT postponement, procedure, cytomegalovirus [CMV] recipient serology reinterpretation) and minor interventions.

Results: Overall, 765 interventions were observed in 257 of 292 (88%) patients: 88 of 765 (11.5%) major and 677 of 765 (88.5%) minor interventions. Among major interventions, HCT was postponed in 8 of 292 (2.7%) patients and a procedure was requested in 18 of 292 (6.2%) patients. The CMV recipient serostatus was changed from indeterminate/low-titer positive to negative in 60 of 292 (20.5%) patients. Among 677 minor interventions, there were 68 (8.8%) additional consultations with other services requested, 260 (33.7%) additional diagnostic tests requested, 102 (13.2%) additional treatments recommended, 60 (7.8%) non-CMV serology reinterpretations performed, 115 (14.9%) deviations from routine anti-infective prophylaxis, and 72 (9.3%) deviations from routine empirical antibiotic treatment recommendations in case of neutropenic fever.

Conclusions: We are proposing a structured, clearly defined, and comprehensive pretransplant checklist for an effective assessment of infectious disease risks and complications prior to an allogeneic HCT. Further studies or experiences like ours could help to define a global strategy or new models of care to be implemented in HCT centers in the future.

Keywords: allogeneic hematopoietic cell transplant; infectious disease consultation; pre-transplant.

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Conflict of interest statement

Potential conflicts of interest. Y. C. has received consulting fees for advisory board membership from MSD, Novartis, Incyte, BMS, Pfizer, AbbVie, Roche, Jazz, Gilead, Amgen, AstraZeneca, and Servier, and travel support from MSD, Roche, Gilead, Amgen, Incyte, AbbVie, Janssen, AstraZeneca, Jazz, and Sanofi, all via institution. D. N. has received consulting fees from MSD, Pfizer, Takeda, and Gilead and research grants from MSD and Pfizer. All other authors report no potential conflicts.

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