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Post-Transplant Events

Risk factors for fatal infectious complications developing late after allogeneic stem cell transplantation

Bone Marrow Transplantation volume 40, pages 1055–1062 (2007)Cite this article

Abstract

Infectious complications remain a major problem contributing to significant mortality after hematopoietic allogeneic stem cell transplantation (HSCT). Few studies have previously analyzed mortality due to late infections. Forty-four patients dying from an infectious complication were identified from a cohort of 688 consecutive patients surviving more than 6 months without relapse. A control group of 162 patients was selected using the year of HSCT as the matching criterion. Out of 44 patients, 30 (68%) died from pneumonia, 7/44 (16%) from sepsis, 5/44 (11%) from central nervous system infection and 2/44 (4.5%) from disseminated varicella. The cumulative incidences of different types of infection were 1.6% for viral, 1.5% for bacterial and 1.3% for fungal infections and 0.15% for Pneumocystis jirovecii pneumonia. The majority (66%) of the lethal infections occurred within 18 months after HSCT. Acute GVHD (relative risk (RR): 7.19, P<0.0001), chronic GVHD (RR: 6.49, P<0.001), CMV infection (RR: 4.69, P=0.001), mismatched or unrelated donor (RR: 3.86, P=0.004) and TBI (RR: 2.65, P=0.047) were independent risk factors of dying from a late infection. In conclusion, infections occurring later than 6 months after HSCT are important contributors to late non-relapse mortality after HSCT. CMV infection or acute GVHD markedly increase the risk.

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Acknowledgements

This study was supported by grants from The Stockholm Cancer Fund and from The Cancer and Traffic Injury Fund, Sweden.

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Authors and Affiliations

  1. and Department of Medicine, Hematology Center, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden

    A Bjorklund, J Aschan & P Ljungman

  2. The European Group for Blood and Marrow Transplantation Acute Leukemia Working Party, Hopital Saint-Antoine Asistance Publique Hopitaux de Paris and Université Paris 6, Pierre et Marie Curie, Paris, France

    M Labopin

  3. and Department of Laboratory Medicine, Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden

    J Aschan, M Remberger & O Ringden

  4. Department of Pediatrics, and Department of Clinical Science, Karolinska University Hospital, Intervention and Technology, Karolinska Institue, Stockholm, Sweden

    J Winiarski

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  1. A Bjorklund
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Bjorklund, A., Aschan, J., Labopin, M. et al. Risk factors for fatal infectious complications developing late after allogeneic stem cell transplantation. Bone Marrow Transplant 40, 1055–1062 (2007). https://doi.org/10.1038/sj.bmt.1705856

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