Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Post-Transplant Complications

Infectious complications and outcomes after allogeneic hematopoietic stem cell transplantation in Korea

Bone Marrow Transplantation volume 34, pages 497–504 (2004)Cite this article

Summary:

We reviewed 242 allogeneic hematopoietic stem cell transplantation (HSCT) recipients retrospectively over a 2-year period (January 1998–December 1999) in order to analyze the characteristics and assess the outcomes of infectious complications in patients after HSCT in Korea. Bacteria were the major pathogens before engraftment, and viral and fungal infections predominated during the post-engraftment period. Varicella zoster virus was the most common viral pathogen after engraftment. Cytomegalovirus disease occurred mainly in the late-recovery phase. The frequency of mold infection was higher than that of yeast. There was a relatively high incidence of tuberculosis (3.0%) and Pneumocystis carinii pneumonia (6.5%). One case of death by measles confirmed by autopsy was also noted. Overall, cumulative mortality was 43% (104/242), and 59.6% of these deaths (62/104) were infection-related. Allogeneic HSCT recipents from unrelated donors were prone to infectious complication and higher mortality than those from matched sibling (17/39 (43.6%) vs 45/203 (22.2%), respectively; P<0.01; odd ratio 2.5; 95% confidence interval 1.2–5.1). As infection was the main post-HSCT complication in our data, more attention should be given to the management of infections in HSCT recipients.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Einsele H, Bertz H, Beyer J et al. Infectious complications after allogeneic stem cell transplantation: epidemiology and interventional therapy strategies. Ann Hematol 2003; 82: s175–s185.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ninin E, Milpied N, Moreau P et al. Longitudinal study of bacterial, viral and fungal infections in adult recipients of bone marrow transplants. Clin Infect Dis 2001; 33: 41–47.

    Article  CAS  PubMed  Google Scholar 

  3. Salutari P, Sica S, Bernardini A et al. Incidence of sepsis after peripheral blood progenitor cells transplant: analysis of 66 consecutive onco-hematological patients. Leuk Lymphoma 1998; 30: 193–197.

    Article  CAS  PubMed  Google Scholar 

  4. Dykewicz CA . Summary of the guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Clin Infect Dis 2001; 33: 139–144.

    Article  CAS  PubMed  Google Scholar 

  5. Weaver CH, Schwartzberg LS, Hainsworth J et al. Treatment-related mortality in 1,000 consecutive patients receiving high-dose chemotherapy and peripheral blood progenitor cell transplantation in community cancer centers. Bone Marrow Transplant 1997; 19: 671–678.

    Article  CAS  PubMed  Google Scholar 

  6. Kolbe K, Domkin D, Derigs HG et al. Infectious complications during neutropenia subsequent to peripheral blood stem cell transplantation. Bone Marrow Transplant 1997; 19: 143–147.

    Article  CAS  PubMed  Google Scholar 

  7. Leather HL, Pharm B, Wingard JR . Infections following hematopoietic stem cell transplantation. Infect Dis Clin NA 2001; 15: 483–520.

    Article  CAS  Google Scholar 

  8. Rubin RH . Infection in transplantation. Infect Dis Clin NA 1995; 9: 823–1043.

    Google Scholar 

  9. Kim DJ, Kim CC, Kim BK et al. Allogeneic bone marrow transplantation in Korea: 1983–1992. Bone Marrow Transplant 1994; 13: 717–719.

    CAS  PubMed  Google Scholar 

  10. Choi JY, Shin WS, Yoo JH et al. Changing trend of infection after allogeneic bone marrow transplantation – comparison between 1983–1988 and 1989–1992. Kor J Antimicrob Chemother 1993; 11: 132–139 (in Korean).

    Google Scholar 

  11. Shin WS, Choi JH, Yoo JH et al. Infectious complications after bone marrow transplantation: experience of Catholic hematopoietic stem cell transplantation center from 1993 to 1996. Kor J Hematopoietic Stem Cell Transplant 1998; 3: 87–98 (in Korean).

    Google Scholar 

  12. Hughes WT, Armstrong D, Bodey GP et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002; 34: 730–751.

    Article  PubMed  Google Scholar 

  13. Ascioglu S, Rex JH, de Pauw B et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002; 34: 7–14.

    Article  CAS  PubMed  Google Scholar 

  14. Ljungman P, Griffiths P, Paya C . Definitions of cytomegalovirus infection and disease in transplant recipients. Cin Infect Dis 2002; 34: 1094–1097.

    Article  Google Scholar 

  15. Thomas ED, Storb R, Clift RA et al. Bone marrow transplantation (second of two parts). N Engl J Med 1975; 292: 895–902.

    Article  CAS  PubMed  Google Scholar 

  16. Sullivan KM, Shulman HM, Storb R et al. Chronic graft-versus-host disease in 52 patients: adverse natural course and successful treatment with combination immunosuppression. Blood 1981; 57: 267–276.

    CAS  PubMed  Google Scholar 

  17. Engels EA, Ellis CA, Supran SE et al. Early infection in bone marrow transplantation: quantitative study of clinical factors that affect risk. Clin Infect Dis 1999; 28: 256–266.

    Article  CAS  PubMed  Google Scholar 

  18. Akiyama H, Kurosu T, Sakashita C et al. Adenovirus is a key pathogen in hemorrhagic cystitis associated with bone marrow transplantation. Clin Infect Dis 2001; 32: 1325–1330.

    Article  CAS  PubMed  Google Scholar 

  19. Bedi A, Miller CB, Hanson JL et al. Association of BK virus with failure of prophylaxis against hemorrhagic cystitis following bone marrow transplantation. J Clin Oncol 1995; 13: 1103–1109.

    Article  CAS  PubMed  Google Scholar 

  20. Azzi A, Cesaro S, Laszlo D et al. Human polyomavirus BK (BKV) load and haemorrhagic cystitis in bone marrow transplantation patients. J Clin Virol 1999; 14: 79–86.

    Article  CAS  PubMed  Google Scholar 

  21. Baddley JW, Stroud TP, Salzman D et al. Invasive mold infections in allogeneic bone marrow transplant recipients. Clin Infect Dis 2001; 32: 1319–1324.

    Article  CAS  PubMed  Google Scholar 

  22. Wald A, Leisenring W, van Burik JA, Bowden RA . Epidemiology of Aspergillus infections in a large cohort of patients undergoing bone marrow transplantation. J Infect Dis 1997; 175: 1459–1466.

    Article  CAS  PubMed  Google Scholar 

  23. Winston DJ, Maziarz RT, Chandrasekar PH et al. Intravenous and oral itraconazole versus intravenous and oral fluconazole for long-term antifungal prophylaxis in allogeneic hematopoietic stem-cell transplant recipients. Ann Intern Med 2003; 138: 705–713.

    Article  CAS  PubMed  Google Scholar 

  24. Marr KA, Seidel K, Slavin MA et al. Prolonged fluconazole prophylaxis is associated with persistent protection against candidiasis-related death in allogeneic marrow transplant recipients: long-term follow-up of a randomized, placebo-controlled trial. Blood 2000; 96: 2055–2061.

    CAS  PubMed  Google Scholar 

  25. Cornely OA, Ullmann AJ, Karthaus M . Evidence-based assessment of primary antifungal prophylaxis in patients with hematologic malignancies. Blood 2003; 101: 3365–3372.

    Article  CAS  PubMed  Google Scholar 

  26. Wingard JR . Antifungal chemoprophylaxis after blood and marrow transplantation. Clin Infect Dis 2002; 34: 1386–1390.

    Article  CAS  PubMed  Google Scholar 

  27. van Delden C, Lew DP, Chapuis B et al. Antifungal prophylaxis in severely neutropenic patients: how much fluconazole is necessary? Clin Microbiol Infect 1995; 1: 24–30.

    Article  CAS  PubMed  Google Scholar 

  28. Philpott-Howard JN, Wade JJ, Mufti GJ et al. Randomized comparison of oral fluconazole vs oral polyene for the prevention of fungal infection in patients at risk of neutro-penia. Multicentre Study Group. J Antimicrob Chemother 1993; 31: 973–984.

    Article  CAS  PubMed  Google Scholar 

  29. Kanda Y, Yamamoto R, Chizuka A et al. Prophylactic action of oral fluconazole against fungal infection in neutropenic patients: a meta-analysis of 16 randomized, controlled trials. Cancer 2000; 89: 1611–1625.

    Article  CAS  PubMed  Google Scholar 

  30. Safdar A, van Rhee F, Henslee-Downey JP et al. Candida glabrata and Candida krusei fungemia after high-risk allogeneic marrow transplantation: no adverse effect of low-dose fluconazole prophylaxis on incidence and outcome. Bone Marrow Transplant 2001; 28: 873–887.

    Article  CAS  PubMed  Google Scholar 

  31. Locksley RM, Flournoy N, Sullivan KM, Meyers JD . Infection with varicella zoster virus after marrow transplantation. J Infect Dis 1985; 152: 1172–1181.

    Article  CAS  PubMed  Google Scholar 

  32. Koc Y, Miller KB, Schenkein DP et al. Varicella zoster virus infections following allogeneic bone marrow transplantation: frequency, risk factors, and clinical outcome. Biol Blood Marrow Transplant 2000; 6: 44–49.

    Article  CAS  PubMed  Google Scholar 

  33. Yoo JH, Kim YR, Shin WS et al. Five cases of cytomegalovirus infection detected by in situ hybridization and antigenemia assay. Korean J Med Sci 1994; 9: 507–512.

    Article  CAS  Google Scholar 

  34. Boeckh M, Leisenring W, Riddell SR et al. Late cytomegalovirus disease and mortality in recipients of allogeneic hematopoietic stem cell transplants: importance of viral load and T-cell immunity. Blood 2003; 101: 407–414.

    Article  CAS  PubMed  Google Scholar 

  35. Nguyen Q, Champlin R, Giralt S et al. Late cytomegalovirus pneumonia in adult allogeneic blood and marrow transplant recipients. Clin Infect Dis 1999; 28: 618–623.

    Article  CAS  PubMed  Google Scholar 

  36. Goodrich JM, Mori M, Gleaves CA et al. Early treatment with ganciclovir to prevent cytomegalovirus disease after allogeneic bone marrow transplantation. N Engl J Med 1991; 325: 1601–1607.

    Article  CAS  PubMed  Google Scholar 

  37. Einsele H, Ehninger G, Hebart H et al. Polymerase chain reaction monitoring reduces the incidence of cytomegalovirus disease and the duration and side effects of antiviral therapy after bone marrow transplantation. Blood 1995; 86: 2815–2820.

    CAS  PubMed  Google Scholar 

  38. Ljungman P, Aschan J, Lewensohn-Fuchs I et al. Results of different strategies for reducing cytomegalovirus-associated mortality in allogeneic stem cell transplant recipients. Transplantation 1998; 66: 1330–1334.

    Article  CAS  PubMed  Google Scholar 

  39. Zaia JA, Gallez-Hawkins GM, Tegtmeier BR et al. Late cytomegalovirus disease in marrow transplantation is predicted by virus load in plasma. J Infect Dis 1997; 176: 782–785.

    Article  CAS  PubMed  Google Scholar 

  40. Roy V, Weisdorf D . Mycobacterial infections following bone marrow transplantation: a 20 year retrospective review. Bone Marrow Transplant 1997; 19: 467–470.

    Article  CAS  PubMed  Google Scholar 

  41. Aljurf M, Gyger M, Alrajhi A et al. Mycobacterium tuberculosis infection in allogeneic bone marrow transplantation patients. Bone Marrow Transplant 1999; 24: 551–554.

    Article  CAS  PubMed  Google Scholar 

  42. de la Camara R, Martino R, Granados E et al. Tuberculosis after hematopoietic stem cell transplantation: incidence, clinical characteristics and outcome. Spanish group on infectious complications in hematopoietic transplantation. Bone Marrow Transplant 2000; 26: 291–298.

    Article  CAS  PubMed  Google Scholar 

  43. Ku SC, Tang JL, Hsueh PR et al. Pulmonary tuberculosis in allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2001; 27: 1293–1297.

    Article  CAS  PubMed  Google Scholar 

  44. Budak-Alpdogan T, Tangun Y, Kalayoglu-Besisik S et al. The frequency of tuberculosis in adult allogeneic stem cell transplant recipients in Turkey. Biol Blood Marrow Transplant 2000; 6: 370–374.

    Article  CAS  PubMed  Google Scholar 

  45. Hong YP, Kim SJ, Lew WJ et al. The seventh nationwide tuberculosis prevalence survey in Korea, 1995. J Tuberc Lung Dis 1998; 2: 27–36.

    CAS  Google Scholar 

  46. Lee J, Lee MH, Kim WS et al. Tuberculosis in hematopoietic stem cell transplant recipients in Korea. Int J Hematol 2004; 79: 185–188.

    Article  PubMed  Google Scholar 

  47. Saito T, Seo S, Kanda Y et al. Early onset Pneumocystis carinii pneumonia after allogeneic peripheral blood stem cell transplantation. Am J Hematol 2001; 67: 206–209.

    Article  CAS  PubMed  Google Scholar 

  48. Tuan IZ, Dennision D, Weisdorf DJ . Pneumocystis carinii pneumonitis following bone marrow transplantation. Bone Marrow Transplant 1992; 10: 267–272.

    CAS  PubMed  Google Scholar 

  49. Lyytikainen O, Ruutu T, Volin L et al. Late onset Pneumocystis carinii pneumonia following allogeneic bone marrow transplantation. Bone Marrow Transplant 1996; 17: 1057–1059.

    CAS  PubMed  Google Scholar 

  50. Machado CM, Goncalves FB, Pannuti CS et al. Measles in bone marrow transplant recipients during an outbreak in Sao Paulo, Brazil. Blood 2002; 99: 83–87.

    Article  CAS  PubMed  Google Scholar 

  51. Na BK, Shin JM, Lee JY et al. Genetic and antigenic characterization of measles viruses that circulated in Korea during the 2000–2001 epidemic. J Med Virol 2003; 70: 649–654.

    Article  PubMed  Google Scholar 

  52. Weisdorf DJ, Anasetti C, Antin JH et al. Allogeneic bone marrow transplantation for chronic myelogenous leukemia: comparative analysis of unrelated vs matched sibling donor transplantation. Blood 2002; 99: 1971–1977.

    Article  CAS  PubMed  Google Scholar 

  53. Marks DI, Cullis JO, Ward KN et al. Allogeneic bone marrow transplantation for chronic myeloid leukemia using sibling and volunteer unrelated donors. A comparison of complications in the first 2 years. Ann Intern Med 1993; 119: 207–214.

    Article  CAS  PubMed  Google Scholar 

  54. Takenaka K, Gondo H, Tanimoto K et al. Increased incidence of cytomegalovirus (CMV) infection and CMV associated disease after allogeneic bone marrow transplantation from unrelated donors. Bone Marrow Transplant 1997; 19: 241–248.

    Article  CAS  PubMed  Google Scholar 

  55. de la Camara R, Fernandez-Ranada JM . Increased incidence of CMV infection after allogeneic bone marrow transplantation from unrelated donors but doubts about an increase in CMV-associated disease. Bone Marrow Transplant 1997; 20: 181.

    Article  CAS  PubMed  Google Scholar 

  56. Loberia Jr F . Reports on state of the art in blood and marrow transplantation – Part I of the IBMTR/ABMTR summary slides with guide. IBMTR/ABMTR Newsletter 2003; 10: 7–10. http://instruct.mcw.edu/IBMTR/BWebServer/summarysldset/summset.htm.

    Google Scholar 

Download references

Acknowledgements

We appreciate professor Julian Gross, Emeritus professor of Biochemistry, Oxford University, UK, for his careful editing and grammatical correction of this manuscript.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, The Catholic Hematopoietic Stem Cell Transplantion Center, College of Medicine, The Catholic University of Korea, Seoul, Korea

    J-H Yoo, D-G Lee, S M Choi, J-H Choi, Y-H Park, Y-J Kim, H-J Kim, S Lee, D-W Kim, J-W Lee, W-S Min, W-S Shin & C-C Kim

Authors
  1. J-H Yoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D-G Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S M Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J-H Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Y-H Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Y-J Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. H-J Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. D-W Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. J-W Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. W-S Min
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. W-S Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. C-C Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J-H Yoo.

Additional information

Part of this study was presented at the 29th World Congress of the International Society of Hematology (August-24–28, 2002), Seoul, South Korea.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yoo, JH., Lee, DG., Choi, S. et al. Infectious complications and outcomes after allogeneic hematopoietic stem cell transplantation in Korea. Bone Marrow Transplant 34, 497–504 (2004). https://doi.org/10.1038/sj.bmt.1704636

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1704636

Keywords

This article is cited by

Search

Advanced search

Quick links