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Outcomes of severe aplastic anemia patients with infection proceeding with allogeneic hematopoietic stem cell transplantation, versus patients without infection

Bone Marrow Transplantation volume 56, pages 2591–2594 (2021)Cite this article

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How should we select specific treatments for severe aplastic anemia (SAA) patients in the presence of active infection is still the challenge in the management of these patients. Infection is an adverse factor for outcome after allogeneic hematopoietic stem cell transplantation (allo-HSCT) [1]. However, it is sometimes necessary to proceed with HSCT in the presence of active infection because HSCT offers the best chance of early neutrophil recovery, and delaying it can risk progression of the infection [2]. HSCT in SAA patients with active infections is therefore called “salvage therapy” or “salvage transplant”. Xu et al. reported 65 SAA patients with infection who received allo-HSCT and had encouraging results [3]. We do not know, however, the outcomes of SAA patients with infections who proceed with allo-HSCT, compared with those of SAA patients without infection who proceed with said treatment. In this multicenter study, we retrospectively summarized 133 SAA patients with active infections who received allo-HSCT as “first-line salvage therapy” between July 2005 and August 2019 and compared them with 300 SAA patients without infection who underwent allo-HSCT during the same time period. All patients provided written informed consent for the protocol. This study was approved by the Ethics Committees of our centers.

Infection was assessed per The Common Terminology Criteria for Adverse Events Version 4.0 [4]. Details of the treatment of infection, conditioning regimen, graft collection and infusion, GVHD prophylaxis and treatment strategy, supportive care and post-transplantation surveillance, and other supportive care are consistent with our previous experience [3, 5].

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References

  1. Killick SB, Bown N, Cavenagh J, Dokal I, Foukaneli T, Hill A, et al. Guidelines for the diagnosis and management of adult aplastic anaemia. Br J Haematol. 2016;172:187–207.

    Article  Google Scholar 

  2. Marsh JC, Ball SE, Cavenagh J, Darbyshire P, Dokal I, Gordon-Smith EC, et al. Guidelines for the diagnosis and management of aplastic anaemia. Br J Haematol. 2009;147:43–70.

    Article  CAS  Google Scholar 

  3. Xu S, Wu L, Zhang Y, Mo W, Zhou M, Li Y, et al. Allogeneic hematopoietic stem cell transplantation for the treatment of severe aplastic anemia patients with infection: a single-center retrospective study. Biol Blood Marrow Transpl. 2018;24:2532–9.

    Article  Google Scholar 

  4. Chen AP, Setser A, Anadkat MJ, Cotliar J, Olsen EA, Garden BC, et al. Grading dermatologic adverse events of cancer treatments: the common terminology criteria for adverse events version 4.0. J Am Acad Dermatol. 2012;67:1025–39.

    Article  Google Scholar 

  5. Liu L, Liu S, Zhang Y, Zhou H, Wang Q, Tian H, et al. Excellent outcomes of allogeneic hematopoietic stem cell transplantation in patients with paroxysmal nocturnal hemoglobinuria: a single-center study. Biol Blood Marrow Transpl. 2019;25:1544–9.

    Article  Google Scholar 

  6. Rosenfeld S, Follmann D, Nunez O, Young NS. Antithymocyte globulin and cyclosporine for severe aplastic anemia: association between hematologic response and long-term outcome. JAMA. 2003;289:1130–5.

    Article  CAS  Google Scholar 

  7. Champlin RE, Horowitz MM, van Bekkum DW, Camitta BM, Elfenbein GE, Gale RP, et al. Graft failure following bone marrow transplantation for severe aplastic anemia: risk factors and treatment results. Blood. 1989;73:606–13.

    Article  CAS  Google Scholar 

  8. Poutsiaka DD, Munson D, Price LL, Chan GW, Snydman DR. Blood stream infection (BSI) and acute graft versus host disease (GVHD) after hematopoietic stem cell transplantation (HSCT) are associated. Bone Marrow Transpl. 2011;46:300–7.

    Article  CAS  Google Scholar 

  9. Rashidi A, Khoruts A, Weisdorf DJ. Infection followed by graft-versus-host disease: pathogenic role of antibiotics. Biol Blood Marrow Transpl. 2017;23:1038–9.

    Article  CAS  Google Scholar 

  10. Poutsiaka DD, Price LL, Ucuzian A, Chan GW, Miller KB, Snydman DR. Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality. Bone Marrow Transpl. 2007;40:63–70.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This work was partially supported by grants from the National Natural Science Foundation of China (81730003), National Science and Technology Major Project (2017ZX09304021), National Key R&D Program of China (2019YFC0840604, 2017YFA0104502), Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD), Jiangsu Medical Outstanding Talents Project (JCRCA2016002), Jiangsu Provincial Key Medical Center (YXZXA2016002).

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  1. These authors contributed equally: Limin Liu, Miao Miao, Xiaowei Chen

Authors and Affiliations

  1. National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, China

    Limin Liu, Miao Miao, Huifen Zhou, Qingyuan Wang, Huiying Qiu, Xiaowen Tang, Yue Han, Chengcheng Fu, Zhengming Jin, Suning Chen, Aining Sun & Depei Wu

  2. Department of Hematology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China

    Xiaowei Chen & Shunqing Wang

  3. Department of Hematology, The Affiliated Huai’an Hospital of Xuzhou Medical University and The Second People’s Hospital of Huai’an, Huai’an, China

    Yanming Zhang

  4. Department of Hematology in Haikou Municipal People’s Hospital, Affiliated Haikou Hospital Xiangya School of Medicine Central South University, Haikou, Hainan, China

    Meiqing Lei

  5. Department of Hematology, Children’s Hospital of Soochow University, Suzhou, China

    Bohan Li

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  1. Limin Liu
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Correspondence to Shunqing Wang or Depei Wu.

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Liu, L., Miao, M., Chen, X. et al. Outcomes of severe aplastic anemia patients with infection proceeding with allogeneic hematopoietic stem cell transplantation, versus patients without infection. Bone Marrow Transplant 56, 2591–2594 (2021). https://doi.org/10.1038/s41409-021-01398-4

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