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Infectious complications after second allogeneic hematopoietic cell transplant in adult patients with hematological malignancies

Bone Marrow Transplantation volume 57, pages 1820–1826 (2022)Cite this article

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Abstract

We conducted a retrospective review of the infectious complications and outcomes over a 2-year follow-up period of adult patients who received a second allogeneic hematopoietic cell transplant (2nd allo-HCT) during a five-year period at two cancer centers in Michigan. Sixty patients, of whom 44 (73%) had acute leukemia or myelodysplastic syndrome, were studied. The majority (n = 37,62%) received a 2nd allo-HCT because of relapsed leukemia. Infection episodes after the 2nd allo-HCT totaled 112. Bacteria were identified in 76 episodes, the majority of which occurred pre-engraftment. The most common infecting organisms were Enterococcus species and Clostridioides difficile. Viral infections, predominantly cytomegalovirus, accounted for 59 infection episodes and occurred mostly in pre-engraftment and early post-engraftment periods. There were 16 proven/probable fungal infections, of which 9 were invasive aspergillosis or candidiasis. Mortality was 45% (n = 27) at one year and 65% (n = 39) at 2 years after transplant, and 16 deaths (41%) were due to infection. Of those 16 infection deaths, 8 were bacterial, 4 fungal, 2 both bacterial and fungal, and 2 viral. Failure to engraft neutrophils or platelets was significantly associated with decreased survival, p < 0.0001 and p < 0.001, respectively. Infections are common after a 2nd allo-HCT and are associated with a high mortality rate.

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Fig. 1: Survival related to neutrophil and platelet engraftment after second Allogeneic Stem Cell Transplant.

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Authors and Affiliations

  1. Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, MI, USA

    Stephen M. Maurer, Kathleen A. Linder, Carol A. Kauffman & Marisa H. Miceli

  2. VA Ann Arbor Healthcare System, Ann Arbor, MI, USA

    Kathleen A. Linder & Carol A. Kauffman

  3. Karmanos Cancer Center and Wayne State University School of Medicine, Detroit, MI, USA

    Philip J. McDonald, Jonathan Arcobello, Jon Velasco, Pranatharthi H. Chandrasekar & Sanjay G. Revankar

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  1. Stephen M. Maurer
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Contributions

SMM: data collection, manuscript writing. KAL: data collection, result interpretation, manuscript writing. CAK: result interpretation, manuscript writing. PM: data collection. JA: data collection. PC: study design, manuscript review. SR: data collection, manuscript review. MHM: study design, data analysis, result interpretation, manuscript review.

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Correspondence to Marisa H. Miceli.

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Maurer, S.M., Linder, K.A., Kauffman, C.A. et al. Infectious complications after second allogeneic hematopoietic cell transplant in adult patients with hematological malignancies. Bone Marrow Transplant 57, 1820–1826 (2022). https://doi.org/10.1038/s41409-022-01827-y

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