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Early blood stream infection following allogeneic hematopoietic stem cell transplantation is a risk factor for acute grade III–IV GVHD in children and adolescents
Author(s) -
Sano Hirozumi,
Hilinski Joseph A.,
Qayed Muna,
Applegate Kristy,
Newton Joanna G.,
Watkins Benjamin,
Chiang KuangYueh,
Horan John
Publication year - 2018
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.26821
Subject(s) - medicine , hematopoietic stem cell transplantation , cumulative incidence , hazard ratio , transplantation , incidence (geometry) , risk factor , graft versus host disease , retrospective cohort study , disease , multivariate analysis , immunology , confidence interval , physics , optics
Background Graft‐versus‐host disease (GVHD) remains a major cause of mortality and morbidity in allogeneic hematopoietic stem cell transplantation (HSCT). In adults, early blood stream infection (BSI) and acute GVHD (AGVHD) have been reported to be related. The impact of BSI on risk for AGVHD, however, has not been assessed in pediatric patients. Procedure We conducted a retrospective analysis to test the hypothesis that early BSI (before day +30) predisposes allogeneic pediatric transplant patients to severe AGVHD. We analyzed 293 allogeneic HSCT performed at Children's Healthcare of Atlanta between 2005 and 2014 that met eligibility criteria. Results The cumulative incidence of acute grade III–IV GVHD at 100 days after HSCT was 17.1%. In multivariate analysis, risk for acute grade III–IV GVHD was associated with HLA‐mismatched donor (hazard ratio [HR] = 4.870, P < 0.001), and BSI between day 0 and +30 prior to AGVHD (HR = 3.010, P = 0.001). Conclusions These results indicate that early BSI appears to be a risk factor for acute grade III–IV GVHD. Further research is needed to determine if the link is causal.