Infections in non-myeloablative hematopoietic stem cell transplantation patients with lymphoid malignancies: spectrum of infections, predictors of outcome and proposed guidelines for fungal infection prevention
The overall risk of infections is lower in patients undergoing non-myeloablative allogeneic stem cell transplantation (NST) than in conventional stem cell transplant recipients. We sought to evaluate conditions associated with increased risk of infections after NST. In 81 patients, 187 infection epi...
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| Veröffentlicht in: | Bone marrow transplantation (Basingstoke) 2010-02, Vol.45 (2), p.339-347 |
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| creator | Safdar, A Rodriguez, G H Mihu, C N Mora-Ramos, L Mulanovich, V Chemaly, R F Champlin, R E Khouri, I |
| description | The overall risk of infections is lower in patients undergoing non-myeloablative allogeneic stem cell transplantation (NST) than in conventional stem cell transplant recipients. We sought to evaluate conditions associated with increased risk of infections after NST. In 81 patients, 187 infection episodes were noted; chronic lymphocytic leukemia (138 episodes/100 person-years) and recipients of matched unrelated donor graft (128 episodes/100 person-years) had higher risk of infection. Only half of the cytomegalovirus (CMV) infections occurred 31–100 days after transplantation. Most patients with CMV infection were non-neutropenic (100%), had lymphoma (76%), were younger (100 days after NST and were associated with high mortality (78%). Most patients with IFI were also not neutropenic (100%), had received MRD graft (100%), had lymphoma (78%) and were given systemic steroids (78%); unlike CMV infection, 67% of these patients also had GVHD. On the basis of our results, we propose that NST recipients with lymphoma treated with high-dose corticosteroids for GVHD be considered for antifungal prophylaxis or pre-emptive antifungal therapy. |
| doi_str_mv | 10.1038/bmt.2009.149 |
| format | Article |
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We sought to evaluate conditions associated with increased risk of infections after NST. In 81 patients, 187 infection episodes were noted; chronic lymphocytic leukemia (138 episodes/100 person-years) and recipients of matched unrelated donor graft (128 episodes/100 person-years) had higher risk of infection. Only half of the cytomegalovirus (CMV) infections occurred 31–100 days after transplantation. Most patients with CMV infection were non-neutropenic (100%), had lymphoma (76%), were younger (<55 years; 72%) and had received matched related donor (MRD) graft (72%). However, graft-versus-host disease (GVHD) was present in only 15% of these patients. Seven (78%) of nine invasive fungal infections (IFI) were diagnosed >100 days after NST and were associated with high mortality (78%). Most patients with IFI were also not neutropenic (100%), had received MRD graft (100%), had lymphoma (78%) and were given systemic steroids (78%); unlike CMV infection, 67% of these patients also had GVHD. On the basis of our results, we propose that NST recipients with lymphoma treated with high-dose corticosteroids for GVHD be considered for antifungal prophylaxis or pre-emptive antifungal therapy.</description><identifier>ISSN: 0268-3369</identifier><identifier>EISSN: 1476-5365</identifier><identifier>DOI: 10.1038/bmt.2009.149</identifier><identifier>PMID: 19561648</identifier><identifier>CODEN: BMTRE9</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Bacterial Infections - etiology ; Biological and medical sciences ; Bone marrow ; Bone marrow, stem cells transplantation. Graft versus host reaction ; Care and treatment ; Cell Biology ; Chronic infection ; Chronic lymphocytic leukemia ; Corticoids ; Corticosteroids ; Cytomegalovirus ; Cytomegalovirus Infections - prevention & control ; Female ; Fungi ; Fungicides ; Graft versus host disease ; Graft vs Host Disease - prevention & control ; Graft-versus-host reaction ; Grafting ; Health risks ; Hematologic and hematopoietic diseases ; Hematology ; Hematopoietic Stem Cell Transplantation - adverse effects ; Hematopoietic stem cells ; Humans ; Infections ; Internal Medicine ; Invasiveness ; Kaplan-Meier Estimate ; Leukemia ; Leukemia, Lymphocytic, Chronic, B-Cell - complications ; Leukemia, Lymphocytic, Chronic, B-Cell - mortality ; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis ; Lymphatic leukemia ; Lymphoma ; Lymphoma, Non-Hodgkin - complications ; Lymphoma, Non-Hodgkin - mortality ; Lymphomas ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Middle Aged ; Mycoses ; Mycoses - etiology ; Mycoses - prevention & control ; Neutropenia ; Opportunistic Infections - prevention & control ; original-article ; Patient outcomes ; Prevention ; Prophylaxis ; Public Health ; Retrospective Studies ; Risk ; Risk factors ; Stem cell transplantation ; Stem Cells ; Steroid hormones ; Transfusions. Complications. Transfusion reactions. Cell and gene therapy ; Transplantation ; Transplantation Conditioning</subject><ispartof>Bone marrow transplantation (Basingstoke), 2010-02, Vol.45 (2), p.339-347</ispartof><rights>Macmillan Publishers Limited 2010</rights><rights>2015 INIST-CNRS</rights><rights>COPYRIGHT 2010 Nature Publishing Group</rights><rights>Copyright Nature Publishing Group Feb 2010</rights><rights>Macmillan Publishers Limited 2010.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c542t-bfde76a62111ce0d33aad0a88dcd1ee9ed87d67d40540d734afa8438c62adab3</citedby><cites>FETCH-LOGICAL-c542t-bfde76a62111ce0d33aad0a88dcd1ee9ed87d67d40540d734afa8438c62adab3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/bmt.2009.149$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/bmt.2009.149$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22431819$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19561648$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Safdar, A</creatorcontrib><creatorcontrib>Rodriguez, G H</creatorcontrib><creatorcontrib>Mihu, C N</creatorcontrib><creatorcontrib>Mora-Ramos, L</creatorcontrib><creatorcontrib>Mulanovich, V</creatorcontrib><creatorcontrib>Chemaly, R F</creatorcontrib><creatorcontrib>Champlin, R E</creatorcontrib><creatorcontrib>Khouri, I</creatorcontrib><title>Infections in non-myeloablative hematopoietic stem cell transplantation patients with lymphoid malignancies: spectrum of infections, predictors of outcome and proposed guidelines for fungal infection prevention</title><title>Bone marrow transplantation (Basingstoke)</title><addtitle>Bone Marrow Transplant</addtitle><addtitle>Bone Marrow Transplant</addtitle><description>The overall risk of infections is lower in patients undergoing non-myeloablative allogeneic stem cell transplantation (NST) than in conventional stem cell transplant recipients. We sought to evaluate conditions associated with increased risk of infections after NST. In 81 patients, 187 infection episodes were noted; chronic lymphocytic leukemia (138 episodes/100 person-years) and recipients of matched unrelated donor graft (128 episodes/100 person-years) had higher risk of infection. Only half of the cytomegalovirus (CMV) infections occurred 31–100 days after transplantation. Most patients with CMV infection were non-neutropenic (100%), had lymphoma (76%), were younger (<55 years; 72%) and had received matched related donor (MRD) graft (72%). However, graft-versus-host disease (GVHD) was present in only 15% of these patients. Seven (78%) of nine invasive fungal infections (IFI) were diagnosed >100 days after NST and were associated with high mortality (78%). Most patients with IFI were also not neutropenic (100%), had received MRD graft (100%), had lymphoma (78%) and were given systemic steroids (78%); unlike CMV infection, 67% of these patients also had GVHD. On the basis of our results, we propose that NST recipients with lymphoma treated with high-dose corticosteroids for GVHD be considered for antifungal prophylaxis or pre-emptive antifungal therapy.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Bacterial Infections - etiology</subject><subject>Biological and medical sciences</subject><subject>Bone marrow</subject><subject>Bone marrow, stem cells transplantation. Graft versus host reaction</subject><subject>Care and treatment</subject><subject>Cell Biology</subject><subject>Chronic infection</subject><subject>Chronic lymphocytic leukemia</subject><subject>Corticoids</subject><subject>Corticosteroids</subject><subject>Cytomegalovirus</subject><subject>Cytomegalovirus Infections - prevention & control</subject><subject>Female</subject><subject>Fungi</subject><subject>Fungicides</subject><subject>Graft versus host disease</subject><subject>Graft vs Host Disease - prevention & control</subject><subject>Graft-versus-host reaction</subject><subject>Grafting</subject><subject>Health risks</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Hematology</subject><subject>Hematopoietic Stem Cell Transplantation - adverse effects</subject><subject>Hematopoietic stem cells</subject><subject>Humans</subject><subject>Infections</subject><subject>Internal Medicine</subject><subject>Invasiveness</subject><subject>Kaplan-Meier Estimate</subject><subject>Leukemia</subject><subject>Leukemia, Lymphocytic, Chronic, B-Cell - complications</subject><subject>Leukemia, Lymphocytic, Chronic, B-Cell - mortality</subject><subject>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</subject><subject>Lymphatic leukemia</subject><subject>Lymphoma</subject><subject>Lymphoma, Non-Hodgkin - complications</subject><subject>Lymphoma, Non-Hodgkin - mortality</subject><subject>Lymphomas</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mycoses</subject><subject>Mycoses - etiology</subject><subject>Mycoses - prevention & control</subject><subject>Neutropenia</subject><subject>Opportunistic Infections - prevention & control</subject><subject>original-article</subject><subject>Patient outcomes</subject><subject>Prevention</subject><subject>Prophylaxis</subject><subject>Public Health</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>Risk factors</subject><subject>Stem cell transplantation</subject><subject>Stem Cells</subject><subject>Steroid hormones</subject><subject>Transfusions. Complications. 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Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Bacterial Infections - etiology</topic><topic>Biological and medical sciences</topic><topic>Bone marrow</topic><topic>Bone marrow, stem cells transplantation. Graft versus host reaction</topic><topic>Care and treatment</topic><topic>Cell Biology</topic><topic>Chronic infection</topic><topic>Chronic lymphocytic leukemia</topic><topic>Corticoids</topic><topic>Corticosteroids</topic><topic>Cytomegalovirus</topic><topic>Cytomegalovirus Infections - prevention & control</topic><topic>Female</topic><topic>Fungi</topic><topic>Fungicides</topic><topic>Graft versus host disease</topic><topic>Graft vs Host Disease - prevention & control</topic><topic>Graft-versus-host reaction</topic><topic>Grafting</topic><topic>Health risks</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Hematology</topic><topic>Hematopoietic Stem Cell Transplantation - adverse effects</topic><topic>Hematopoietic stem cells</topic><topic>Humans</topic><topic>Infections</topic><topic>Internal Medicine</topic><topic>Invasiveness</topic><topic>Kaplan-Meier Estimate</topic><topic>Leukemia</topic><topic>Leukemia, Lymphocytic, Chronic, B-Cell - complications</topic><topic>Leukemia, Lymphocytic, Chronic, B-Cell - mortality</topic><topic>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</topic><topic>Lymphatic leukemia</topic><topic>Lymphoma</topic><topic>Lymphoma, Non-Hodgkin - complications</topic><topic>Lymphoma, Non-Hodgkin - mortality</topic><topic>Lymphomas</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mycoses</topic><topic>Mycoses - etiology</topic><topic>Mycoses - prevention & control</topic><topic>Neutropenia</topic><topic>Opportunistic Infections - prevention & control</topic><topic>original-article</topic><topic>Patient outcomes</topic><topic>Prevention</topic><topic>Prophylaxis</topic><topic>Public Health</topic><topic>Retrospective Studies</topic><topic>Risk</topic><topic>Risk factors</topic><topic>Stem cell transplantation</topic><topic>Stem Cells</topic><topic>Steroid hormones</topic><topic>Transfusions. Complications. Transfusion reactions. 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We sought to evaluate conditions associated with increased risk of infections after NST. In 81 patients, 187 infection episodes were noted; chronic lymphocytic leukemia (138 episodes/100 person-years) and recipients of matched unrelated donor graft (128 episodes/100 person-years) had higher risk of infection. Only half of the cytomegalovirus (CMV) infections occurred 31–100 days after transplantation. Most patients with CMV infection were non-neutropenic (100%), had lymphoma (76%), were younger (<55 years; 72%) and had received matched related donor (MRD) graft (72%). However, graft-versus-host disease (GVHD) was present in only 15% of these patients. Seven (78%) of nine invasive fungal infections (IFI) were diagnosed >100 days after NST and were associated with high mortality (78%). Most patients with IFI were also not neutropenic (100%), had received MRD graft (100%), had lymphoma (78%) and were given systemic steroids (78%); unlike CMV infection, 67% of these patients also had GVHD. On the basis of our results, we propose that NST recipients with lymphoma treated with high-dose corticosteroids for GVHD be considered for antifungal prophylaxis or pre-emptive antifungal therapy.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>19561648</pmid><doi>10.1038/bmt.2009.149</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0268-3369 |
| ispartof | Bone marrow transplantation (Basingstoke), 2010-02, Vol.45 (2), p.339-347 |
| issn | 0268-3369 1476-5365 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_733904210 |
| source | MEDLINE; Springer Nature - Complete Springer Journals; Nature Journals Online; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Bacterial Infections - etiology Biological and medical sciences Bone marrow Bone marrow, stem cells transplantation. Graft versus host reaction Care and treatment Cell Biology Chronic infection Chronic lymphocytic leukemia Corticoids Corticosteroids Cytomegalovirus Cytomegalovirus Infections - prevention & control Female Fungi Fungicides Graft versus host disease Graft vs Host Disease - prevention & control Graft-versus-host reaction Grafting Health risks Hematologic and hematopoietic diseases Hematology Hematopoietic Stem Cell Transplantation - adverse effects Hematopoietic stem cells Humans Infections Internal Medicine Invasiveness Kaplan-Meier Estimate Leukemia Leukemia, Lymphocytic, Chronic, B-Cell - complications Leukemia, Lymphocytic, Chronic, B-Cell - mortality Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis Lymphatic leukemia Lymphoma Lymphoma, Non-Hodgkin - complications Lymphoma, Non-Hodgkin - mortality Lymphomas Male Medical sciences Medicine Medicine & Public Health Middle Aged Mycoses Mycoses - etiology Mycoses - prevention & control Neutropenia Opportunistic Infections - prevention & control original-article Patient outcomes Prevention Prophylaxis Public Health Retrospective Studies Risk Risk factors Stem cell transplantation Stem Cells Steroid hormones Transfusions. Complications. Transfusion reactions. Cell and gene therapy Transplantation Transplantation Conditioning |
| title | Infections in non-myeloablative hematopoietic stem cell transplantation patients with lymphoid malignancies: spectrum of infections, predictors of outcome and proposed guidelines for fungal infection prevention |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-10T17%3A43%3A18IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Infections%20in%20non-myeloablative%20hematopoietic%20stem%20cell%20transplantation%20patients%20with%20lymphoid%20malignancies:%20spectrum%20of%20infections,%20predictors%20of%20outcome%20and%20proposed%20guidelines%20for%20fungal%20infection%20prevention&rft.jtitle=Bone%20marrow%20transplantation%20(Basingstoke)&rft.au=Safdar,%20A&rft.date=2010-02-01&rft.volume=45&rft.issue=2&rft.spage=339&rft.epage=347&rft.pages=339-347&rft.issn=0268-3369&rft.eissn=1476-5365&rft.coden=BMTRE9&rft_id=info:doi/10.1038/bmt.2009.149&rft_dat=%3Cgale_proqu%3EA219375370%3C/gale_proqu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=216662541&rft_id=info:pmid/19561648&rft_galeid=A219375370&rfr_iscdi=true |