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The impact of graft cell source on bloodstream infection in the first 100 days after allogeneic hematopoietic cell transplantation


Bloodstream infection (BSI) is a major infectious complication after allogeneic hematopoietic cell transplantation (HCT). To clarify the impact of graft cell source on the incidence of BSI after transplantation, we retrospectively examined 782 adult patients receiving their first allogeneic HCT: 122 recipients of related peripheral blood stem cells or bone marrow, 215 recipients of unrelated bone marrow, and 445 recipients of unrelated umbilical cord blood (U-CB). The cumulative incidence of BSI was 42.5% at 100 days after transplantation (95% confidence interval, 39.0–46.0). Gram-positive cocci were present in 64.2% of detected isolates. Among the pre-transplant factors including age, performance status, primary disease, disease status, graft cell source, sex and ABO blood type matching, and the intensity of conditioning regimen, U-CB use was identified as the most significant risk factor for BSI by multivariate analysis (hazard ratio, 1.76; 95% confidence interval, 1.40–2.22; p < 0.00001). Among the U-CB recipients, those who are not in remission at the time of transplantation were at the greatest risk of BSI (hazard ratio, 1.69; 95% confidence interval, 1.14–2.50; p < 0.01). The study makes it clear that graft cell source has an impact on BSI development after allogeneic HCT.

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Fig. 1: Cumulative incidence of bloodstream infection.
Fig. 2: Cumulative incidence of each Gram stain classification (A), and number of occurrences of each Gram stain classification by time series (B).


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The authors thank the patients and the donors. We also thank physicians, nurses, pharmacists, transplantation coordinator (Ms. Madoka Narita), data managers (Ms. Rumiko Tsuchihashi and Ms. Kaori Kobayashi), other co-medical staffs, and support personnel for their care of the patients involved in the study.

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Authors and Affiliations



S. Takagi is the principal investigator and takes primary responsibility for the paper; S. Takagi wrote the manuscript; S. Takagi, NU, TM, MY, KK, DK, YT, AN, K. Ishiwata., H.Y., G.Y., Y.A-M, K. Izutsu., AW and S. Taniguchi treated patients and reviewed the final manuscript; SO, HA, MK, YK and SM reviewed the final manuscript; S. Takagi, AY, and S. Taniguchi designed the research; AY and S. Taniguchi organized the project.

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Correspondence to Shinsuke Takagi.

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Takagi, S., Ogura, S., Araoka, H. et al. The impact of graft cell source on bloodstream infection in the first 100 days after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 56, 1625–1634 (2021).

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