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The influence of infection early after allogeneic stem cell transplantation on the risk of leukemic relapse and graft‐versus‐host disease
Author(s) -
Kim SungYong,
Lee DongGun,
Kim MyungShin,
Kim HeeJe,
Lee Seok,
Min ChangKi
Publication year - 2008
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.21227
Subject(s) - medicine , transplantation , stem cell , leukemia , donor lymphocyte infusion , immunology , proinflammatory cytokine , disease , graft versus host disease , hematopoietic stem cell transplantation , risk factor , bone marrow , gastroenterology , oncology , biology , inflammation , genetics
Abstract An infection after allogeneic stem cell transplantation (SCT) can affect the activity of immune cells and increase the level of proinflammatory cytokines. Further, a post‐SCT infection may influence the milieu of the graft‐versus‐leukemia (GVL) effect and graft‐versus‐host disease (GVHD). We performed a retrospective study of patients with acute leukemia who had undergone allogeneic SCT using the same preparative regimens and bone marrow as the stem cell source to determine if early post‐transplant infection was associated with the risk of leukemic relapse and GVHD. The analysis revealed that patients who had a febrile infection (FI) before post‐transplant day 21 (FI group) had a lower actuarial probability of leukemic relapse ( P < 0.001) and a higher relapse‐free survival rate ( P = 0.012) than those patients who did not have a FI before post‐transplant day 21 (non‐FI group). The experience of early post‐transplant FI (HR = 0.316; 95% CI = 0.174–0.575; P < 0.001), together with the presence of chronic GVHD and high risk cytogenetics, were independent predictive factors for post‐transplant leukemic relapse. The FI group had a trend towards a higher lymphocyte count on post‐transplant day 21 than the non‐FI group ( P = 0.063), despite the delayed recovery of the platelet count and a trend towards delayed recovery of the neutrophil count. These findings suggest that a change in the immunologic network by infectious diseases in the early post‐transplant period favors the milieu of the GVL effect. The specific immunologic change during FI, which can potentiate the GVL effect, remains to be determined. Am. J. Hematol., 2008. © 2008 Wiley‐Liss, Inc.