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Legionellosis after hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 56, pages 2555–2566 (2021)Cite this article

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Abstract

Limited data are available on legionellosis after hematopoietic stem cell transplant (HSCT). The aim of this study was to report the cases of legionellosis and to identify predictors of legionellosis, legionellosis-associated death, and non-relapse mortality (NRM). All cases of post-HSCT legionellosis from the EBMT registry were included and matched with controls in a 3:1 ratio for the analyses of risk factors. In the years 1995–2016, 80 cases from 52 centers in 14 countries were identified (mainly from France, Italy, and Spain). Median time from HSCT to legionellosis was 203 days (range, 0–4099); 19 (23.8%) patients developed early legionellosis (within-day +30 post-HSCT). Patients were mainly male (70%), after allogeneic HSCT (70%), with acute leukemia (27.5%), lymphoma (23.8%), or multiple myeloma (21.3%), and the median age of 46.6 (range, 7.2–68.2). Predictors of legionellosis were allogeneic HSCT (OR = 2.27, 95%CI:1.08–4.80, p = 0.03) and recent other infection (OR = 2.96, 95%CI:1.34–6.52, p = 0.007). Twenty-seven (33.8%) patients died due to legionellosis (44% after early legionellosis), NRM was 50%. Predictors of NRM were female sex (HR = 2.19, 95%CI:1.13–4.23, p = 0.02), early legionellosis (HR = 2.24, 95%CI:1.13–4.46, p = 0.02), and south-eastern geographical region (HR = 2.16, 95%CI:1.05–4.44, p = 0.036). In conclusion, legionellosis is a rare complication after HSCT, mainly allogeneic, occurring frequently within 30 days after HSCT and associated with high mortality.

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Fig. 1: Timing of legionellosis after HSCT.
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Authors and Affiliations

  1. Department of Health Sciences (DISSAL), University of Genova, Genova, Italy

    Malgorzata Mikulska

  2. Division of Infectious Diseases, Ospedale Policlinico San Martino, Genova, Italy

    Malgorzata Mikulska

  3. Policlinico G.B. Rossi, Verona, Italy

    Gloria Tridello

  4. EBMT Data Office, Leiden, The Netherlands

    Jennifer Hoek

  5. Poznan University of Medical Sciences, Poznan, Poland

    Lidia Gil

  6. Hospital U. Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain

    Lucrecia Yañez

  7. Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France

    Hélène Labussière-Wallet

  8. University Hospital, Basel, Switzerland

    Jakob Passweg

  9. Hôpital St. Louis, Paris, France

    Aliénor Xhaard

  10. Ospedale San Gerardo, Monza, Italy

    Pietro Pioltelli

  11. CHU de Dijon, Dijon, France

    Denis Caillot

  12. Department of Paediatric Haematology and Oncology, Timone Children Hospital and Aix-Marseille University, Marseille, France

    Gerard Michel

  13. Leiden University Medical Center, Leiden, The Netherlands

    Hendrik Veelken

  14. Institut Paoli Calmettes, Marseille, France

    Didier Blaise

  15. A.O.U. Citta della Salute e della Scienza di Torino, Torino, Italy

    Benedetto Bruno

  16. Service d’Hématologie et de thérapie cellulaire CHU Bordeaux, Hôpital Haut-Lévèque, Bordeaux, France

    Carmen Botella Garcia

  17. HUCH Comprehensive Cancer Center, Helsinki, Finland

    Maija Itälä-Remes

  18. Addenbrookes Hospital, Cambridge, United Kingdom

    Charles Crawley

  19. Gustave Roussy, Villejuif, France

    Jean Henri Bourhis

  20. Tartu University Hospital, Tartu, Estonia

    Ain Kaare

  21. Tor Vergata University, Rome, Italy

    William Arcese

  22. ICO-Hospital Duran I Reynals, Barcelona, Spain

    Rocio Parody

  23. University Hospital, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland

    Jan Styczynski

Authors
  1. Malgorzata Mikulska
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  2. Gloria Tridello
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  3. Jennifer Hoek
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Correspondence to Malgorzata Mikulska.

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Mikulska, M., Tridello, G., Hoek, J. et al. Legionellosis after hematopoietic stem cell transplantation. Bone Marrow Transplant 56, 2555–2566 (2021). https://doi.org/10.1038/s41409-021-01333-7

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