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Infections

Patterns of infection and infection-related mortality in patients with steroid-refractory acute graft versus host disease

Bone Marrow Transplantation volume 52, pages 107–113 (2017)Cite this article

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Abstract

This study aimed to characterize the incidence, etiology and outcome of infectious episodes in patients with steroid refractory acute GvHD (SR-GvHD). The cohort included 127 adults treated with inolimomab (77%) or etanercept (23%) owing to acute 2–4 SR-GvHD, with a response rate of 43% on day +30 and a 4-year survival of 15%. The 1-year cumulative incidences of bacterial, CMV and invasive fungal infection were 74%, 65% and 14%, respectively. A high rate (37%) of enterococcal infections was observed. Twenty patients (15.7%) developed BK virus-hemorrhagic cystitis and five percent had an EBV reactivation with only one case of PTLD. One-third of long-term survivors developed pneumonia by a community respiratory virus and/or encapsulated bacteria, mostly associated with chronic GvHD. Infections were an important cause of non-relapse mortality, with a 4-year incidence of 46%. In multivariate analysis, use of rituximab in the 6 months before SCT (hazard ratio; HR 4.2; 95% confidence interval; CI 1.1–16.3), severe infection before SR-GvHD onset (HR 5.8; 95% CI 1.3–26.3) and a baseline C-reactive protein >15 UI/mL (HR 2.9; 95% CI 1.1–8.5) were associated with infection-related mortality. High rates of opportunistic infections with remarkable mortality warrant further efforts to optimize long-term outcomes after SR-GvHD.

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Acknowledgements

Supported in part by grants AGAUR 2014SGR-1281, RD12/0036/0071, PI14/00450 and PIE15/00028 from ISCIII, a grant from Cellex Research Foundation, Barcelona, Spain, a grant from Jose Carreras Leukemia Research Institute, and a grant from ‘Obra Social La Caixa’, Barcelona.

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  1. D Valcarcel and J Sierra: These authors contributed equally to this work.

Authors and Affiliations

  1. Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

    I García-Cadenas, R Martino, A Esquirol, S Novelli, J Briones, S Brunet & J Sierra

  2. Hematology Department, Hospital Vall d’Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain

    I Rivera, P Barba, G Orti & D Valcarcel

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  1. I García-Cadenas
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  2. I Rivera
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  3. R Martino
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Correspondence to I García-Cadenas.

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García-Cadenas, I., Rivera, I., Martino, R. et al. Patterns of infection and infection-related mortality in patients with steroid-refractory acute graft versus host disease. Bone Marrow Transplant 52, 107–113 (2017). https://doi.org/10.1038/bmt.2016.225

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