Infections in adults undergoing unrelated donor bone marrow transplantation

This study retrospectively reviews infections over a 7‐year period in 60 consecutive adults (median age 25 years) undergoing their first unrelated donor bone marrow transplant (UD‐BMT). T‐cell depletion was employed in 93%. More than half the patients had one or more severe, potentially life‐threatening, infections. There was a high incidence of invasive fungal infections (Aspergillus 17, Candida four), despite the use of itraconazole or amphotericin prophylaxis. Ten Aspergillus infections occurred beyond 100 d. Two patients (11%) with invasive aspergillosis survived. Clustering of infections was noted, with invasive fungal infections significantly associated with bacteraemias (OR 3.73, P = 0.06) and multiple viral infections (OR 4.25, P = 0.05). There were 21 severe viral infections in 16 patients, with CMV disease occurring in four patients only; viral pneumonitis was predominantly due to ‘community respiratory’ viruses. Most early bacteraemias (68%) were due to Gram‐positive organisms. The majority of episodes of Gram‐negative sepsis were caused by non‐fastidious non‐fermentative bacteria, such as Pseudomonas spp. and Acinetobacterspp., historically regarded as organisms of low pathogenicity. In patients with successful engraftment and minimal graft‐versus‐host disease, late infections suggestive of continued immune dysfunction (shingles, recurrent lower respiratory infections, Salmonella enteritis and extensive warts) were common.