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Infectious complications following allogeneic HLA-identical sibling transplantation with antithymocyte globulin-based reduced intensity preparative regimen

Leukemia volume 17, pages 2168–2177 (2003)Cite this article

Abstract

In the setting of reduced-intensity conditioning (RIC) regimens for allogeneic stem cell transplantation (allo-SCT), the epidemiology of transplant-related infections is still poorly defined. In 101 high-risk patients who received an HLA-identical sibling allo-SCT after RIC, including fludarabine, busulfan and antithymocyte globulin (ATG), we report during the first 6 months a cumulative incidence of positive CMV antigenemia of 42% (95% CI 32–52%), developing at a median of 37 (range 7–116) days without evidence of CMV disease (median follow-up, 434 days). The cumulative incidence of bacteremia was 25% (95% CI 17–33%), occurring at a median of 67 (range 7–172) days, while patients had recovered a full neutrophil count. In all, 65% of the bacteremia (95% CI 49–81%) were gram negative. The cumulative incidence of fungal infections was 8% (95% CI 3–13%), with a median onset of 89 (range 7–170) days. In multivariate analysis, stem cell source (bone marrow; P=0.0002) was significantly associated with the risk of positive CMV antigenemia, while higher doses of prednisone (>2 mg/kg) represented the major risk factor for bacteremia (P=0.0001). Infectious-related mortality was 5% (95% CI 1–9%), with aspergillosis being the principal cause. Collectively, these results suggest that prospective efforts are warranted to develop optimal antimicrobial preventive strategies after RIC allo-SCT.

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Acknowledgements

Mohamad Mohty was supported by grants from ‘the Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC)’, the ‘Fondation de France’, the ‘Fondation pour la Recherche Médicale’, the ‘Association pour la Recherche sur le Cancer’, the ‘Association Cent pour Sang la Vie’ (Paris, France), the ‘Association Méditerranéenne pour le Développement de la Transplantation’ (Marseille, France) and from the ‘Ligue contre le Cancer du Gard’ (Nimes, France). We thank FB Petersen, MD (University of Utah Health Sciences Center, Salt Lake City, UT, USA) for critical reading of the manuscript, and B Gaugler (INSERM U119, Marseille) for helpful discussions. We thank the nursing staff for providing excellent care for our patients. We thank AG Le Coroller (INSERM U379, Marseille, France) for help with statistical analysis. We also thank the following physicians at the Institut Paoli-Calmettes for their important study contributions and dedicated patient care: A Gonçalves, F Viret, AC Braud, RT Costello, JM Schiano de Collela, A Charbonnier, R Bouabdallah, GL Damaj, V Ivanov, G Novakovitch, P Ladaique and C Chabannon.

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Authors and Affiliations

  1. Unité de Transplantation et de Thérapie Cellulaire (UTTC), Institut Paoli-Calmettes, Marseille, France

    M Mohty, W Jacot, C Faucher, K Bilger, D Maraninchi & D Blaise

  2. Laboratoire d'Immunologie des Tumeurs, Institut Paoli-Calmettes and Université de la Méditerranée, Marseille, France

    M Mohty & D Olive

  3. Unité de Transplantation Médullaire, Centre Jean-Perrin, Clermont-Ferrand, France

    J O Bay, B Choufi & O Tournilhac

  4. Laboratoire de Virologie, Hôpital de la Timone, Centre Hospitalier et Universitaire de Marseille, Marseille, France

    C Zandotti

  5. Département de Microbiologie, Institut Paoli-Calmettes, Marseille, France

    L Collet

  6. Département d'Hématologie, Institut Paoli-Calmettes and Université de la Méditerranée, Marseille, France

    N Vey, A M Stoppa, D Coso, J A Gastaut, D Maraninchi & D Blaise

  7. Département d'Oncologie Médicale, Institut Paoli-Calmettes and Université de la Méditerranée, Marseille, France

    P Viens & D Maraninchi

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  1. M Mohty
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Mohty, M., Jacot, W., Faucher, C. et al. Infectious complications following allogeneic HLA-identical sibling transplantation with antithymocyte globulin-based reduced intensity preparative regimen. Leukemia 17, 2168–2177 (2003). https://doi.org/10.1038/sj.leu.2403105

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