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

Karen Ballen; Kwang Woo Ahn; Min Chen; Hisham Abdel-Azim; Ibrahim Ahmed; Mahmoud Aljurf; Joseph Antin; Ami S Bhatt; Michael Boeckh; George Chen; Christopher Dandoy; Biju George; Mary J Laughlin; Hillard M Lazarus; Margaret L MacMillan; David A Margolis; David I Marks; Maxim Norkin; Joseph Rosenthal; Ayman Saad; Bipin Savani; Harry C Schouten; Jan Storek; Paul Szabolcs; Celalettin Ustun; Michael R Verneris; Edmund K Waller; Daniel J Weisdorf; Kirsten M Williams; John R Wingard; Baldeep Wirk; Tom Wolfs; Jo-Anne H Young; Jeffrey Auletta; Krishna V Komanduri; Caroline Lindemans; Marcie L Riches

doi:10.1016/j.bbmt.2016.06.012

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

Journal article

Open access

Peer reviewed

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

Karen Ballen, Kwang Woo Ahn, Min Chen, Hisham Abdel-Azim, Ibrahim Ahmed, Mahmoud Aljurf, Joseph Antin, Ami S Bhatt, Michael Boeckh, George Chen, …

Biology of blood and marrow transplantation, Vol.22(9), pp.1636-1645

2016-09

DOI: https://doi.org/10.1016/j.bbmt.2016.06.012

PMCID: PMC5008458

PMID: 27343716

Abstract

Infection

Umbilical cord blood

Leukemia

•Bacterial and viral, but not fungal, infections are more common after umbilical cord blood transplantations than after mismatched unrelated donor transplantations•Bacterial and fungal, but not viral, infections were associated with poorer survival•Overall survival is comparable among graft sources if performance status is ≥ 90% 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.

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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.103 Blood Disorders; 1.103.380 GvHD
Web Of Science research areas: Hematology; Immunology; Transplantation
ESI research areas: Immunology

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Title: Infection Rates among Acute Leukemia Patients Receiving Alternative Donor Hematopoietic Cell Transplantation
Creators: Karen Ballen - Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
Kwang Woo Ahn - Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Min Chen - Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Hisham Abdel-Azim - Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
Ibrahim Ahmed - Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, Missouri
Mahmoud Aljurf - Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia
Joseph Antin - Center for Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
Ami S Bhatt - Stanford University School of Medicine, Stanford, California
Michael Boeckh - Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
George Chen - Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
Christopher Dandoy - Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
Biju George - Christian Medical College, Vellore, India
Mary J Laughlin - Medical Director, Cleveland Cord Blood Center, Cleveland, Ohio
Hillard M Lazarus - Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
Margaret L MacMillan - Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
David A Margolis - Section of Hematology, Oncology and BMT, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
David I Marks - Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
Maxim Norkin - Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida
Joseph Rosenthal - City of Hope National Medical Center, Duarte, California
Ayman Saad - Division of Hematology/Oncology Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Bipin Savani - Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Harry C Schouten - Department of Hematology, Academische Ziekenhuis, Maastricht, Netherlands
Jan Storek - Department of Medicine, University of Calgary, Calgary, Alberta, Canada
Paul Szabolcs - Division of Blood and Marrow Transplantation, Children's National Health System, Washington, District of Columbia
Celalettin Ustun - Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota
Michael R Verneris - Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
Edmund K Waller - Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
Daniel J Weisdorf - Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota
Kirsten M Williams - Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland
John R Wingard - Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida
Baldeep Wirk - Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
Tom Wolfs - Division of Pediatrics, Wilhelmina Children's Hospital, Utrecht, Netherlands
Jo-Anne H Young - Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
Jeffrey Auletta - Host Defense Program, Divisions of Hematology/Oncology/Bone Marrow Transplant and Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio
Krishna V Komanduri - Adult Stem Cell Transplantation Program, University of Miami, Miami, Florida
Caroline Lindemans - Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht, Netherlands
Marcie L Riches - Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Publication Details: Biology of blood and marrow transplantation, Vol.22(9), pp.1636-1645
Publisher: Elsevier Inc
Academic Unit: Miller School of Medicine; UMMG Dept of Medicine - Hematology/Oncology
Language: English
Resource Type: Journal article
PMID: 27343716
PMCID: PMC5008458
Record Identifier: 991031578658902976