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 SaadBipin 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

Research output: Contribution to journalArticle

31 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1636-1645
Number of pages10
JournalBiology of Blood and Marrow Transplantation
Volume22
Issue number9
DOIs
StatePublished - Sep 1 2016

Keywords

  • Infection
  • Leukemia
  • Umbilical cord blood

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Ballen, K., Woo Ahn, K., Chen, M., Abdel-Azim, H., Ahmed, I., Aljurf, M., Antin, J., Bhatt, A. S., Boeckh, M., Chen, G., Dandoy, C., George, B., Laughlin, M. J., Lazarus, H. M., MacMillan, M. L., Margolis, D. A., Marks, D. I., Norkin, M., Rosenthal, J., ... Riches, M. L. (2016). Infection Rates among Acute Leukemia Patients Receiving Alternative Donor Hematopoietic Cell Transplantation. Biology of Blood and Marrow Transplantation, 22(9), 1636-1645. https://doi.org/10.1016/j.bbmt.2016.06.012