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Epidemiology of infections following haploidentical peripheral blood hematopoietic cell transplantation
Author(s) -
Slade Michael,
Goldsmith Scott,
Romee Rizwan,
DiPersio John F.,
Dubberke Erik R.,
Westervelt Peter,
Uy Geoffrey L.,
Lawrence Steven J.
Publication year - 2017
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12629
Subject(s) - medicine , viremia , bacteremia , hemorrhagic cystitis , incidence (geometry) , transplantation , hematopoietic stem cell transplantation , retrospective cohort study , cytomegalovirus , gastroenterology , immunology , epidemiology , cyclophosphamide , chemotherapy , antibiotics , viral disease , human immunodeficiency virus (hiv) , herpesviridae , biology , physics , optics , microbiology and biotechnology
Background The use of T‐cell replete haploidentical hematopoietic cell transplant (haplo‐ HCT ) has increased substantially since the introduction of post‐transplant cyclophosphamide ( PTC y) regimens. Limited data exist concerning infectious complications of haplo‐ HCT utilizing mobilized peripheral blood ( PB ) hematopoietic cells. Methods This retrospective cohort study included all adult patients at our institution undergoing PB haplo‐ HCT with PTC y between June 2009 and June 2015. Infections were microbiologically confirmed. Invasive fungal infections ( IFI ) classified as “proven” or “probable” by standard definitions were included. Results In total, 104 patients were identified. Median follow‐up was 218 days (range: 6–1576). A total of 322 episodes of infection were recorded. Eighty‐nine percent of patients experienced at least one infection. Median time to first infection was 22 days. Patients experiencing at least one bacterial, viral, and IFI were 62%, 72%, and 6%, respectively. The majority (69%) of bacterial infections were caused by enteric organisms. Seven cases of S taphylococcus aureus infection were recorded, with one bacteremia case. Cytomegalovirus ( CMV ) viremia occurred in 54/71 (76%) at‐risk patients at a median time of 24 days. Sixteen (15%) patients developed CMV disease. Nineteen percent (20/104) of patients developed BK polyomavirus‐associated cystitis. Six (6%) patients experienced a total of seven IFI . Infection was the primary cause of death for 12% (6/51) of patients and was a secondary cause for 41%. Conclusion In PB haplo‐ HCT patients, a high incidence of CMV viremia and disease was observed. Infections with enteric bacteria were common. Fungal and staphylococcal infections were uncommon. Further studies are needed to compare infectious complications in haplo‐ HCT with other transplant modalities.