scholarly journals Use of Disinfection Cap to Reduce Central-Line–Associated Bloodstream Infection and Blood Culture Contamination Among Hematology–Oncology Patients

2015 ◽  
Vol 36 (12) ◽  
pp. 1401-1408 ◽  
Author(s):  
Mini Kamboj ◽  
Rachel Blair ◽  
Natalie Bell ◽  
Crystal Son ◽  
Yao-Ting Huang ◽  
...  
Keyword(s):  
High Risk ◽  
Blood Culture ◽  
Bloodstream Infection ◽  
Tertiary Care ◽  
Central Line ◽  
Cancer Center ◽  
Cell Transplant ◽  
Oncology Patients ◽  
Hematopoietic Stem ◽  
The Impact

OBJECTIVEIn this study, we examined the impact of routine use of a passive disinfection cap for catheter hub decontamination in hematology–oncology patients.SETTINGA tertiary care cancer center in New York CityMETHODSIn this multiphase prospective study, we used 2 preintervention phases (P1 and P2) to establish surveillance and baseline rates followed by sequential introduction of disinfection caps on high-risk units (HRUs: hematologic malignancy wards, hematopoietic stem cell transplant units and intensive care units) (P3) and general oncology units (P4). Unit-specific and hospital-wide hospital-acquired central-line–associated bloodstream infection (HA-CLABSI) rates and blood culture contamination (BCC) with coagulase negative staphylococci (CONS) were measured.RESULTSImplementation of a passive disinfection cap resulted in a 34% decrease in hospital-wide HA-CLABSI rates (combined P1 and P2 baseline rate of 2.66–1.75 per 1,000 catheter days at the end of the study period). This reduction occurred only among high-risk patients and not among general oncology patients. In addition, the use of the passive disinfection cap resulted in decreases of 63% (HRUs) and 51% (general oncology units) in blood culture contamination, with an estimated reduction of 242 BCCs with CONS. The reductions in HA-CLABSI and BCC correspond to an estimated annual savings of $3.2 million in direct medical costs.CONCLUSIONRoutine use of disinfection caps is associated with decreased HA-CLABSI rates among high-risk hematology oncology patients and a reduction in blood culture contamination among all oncology patients.Infect. Control Hosp. Epidemiol. 2015;36(12):1401–1408

scholarly journals The Impact of COVID-19 Response on Central Line Associated Bloodstream Infections and Blood Culture Contamination Rates at a Tertiary Care Center in Greater Detroit Area

2020 ◽  
pp. 1-15
Author(s):  
Jennifer LeRose ◽  
Avnish Sandhu ◽  
Jordan Polistico ◽  
Joe Ellsworth ◽  
Mara Cranis ◽  
...  
Keyword(s):  
Blood Culture ◽  
Care Center ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Blood Stream ◽  
Central Line ◽  
Tertiary Care Center ◽  
Blood Stream Infections ◽  
Detroit Area ◽  
The Impact

Abstract A comparative retrospective study to quantify the impact of Coronavirus Disease 2019 (COVID-19) on patient safety. We found a statistically significant increase in central line-associated blood stream infections and blood culture contamination rates during the pandemic. Increased length of stay and mortality was also observed during COVID-19.

Effects of Multiple Myeloma (MM) Therapy and Type of Thromboprophylaxis On the Incidence and Timing of Venous Thromboembolism (VTE) and Factors Predictive of VTE.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2244-2244
Author(s):  
Jatin J. Shah ◽  
Aparna Hegde ◽  
Xiao Zhou ◽  
Sheeba K. Thomas ◽  
Michael Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
Cancer Center ◽  
Hematopoietic Stem ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Multivariate Proportional Hazard ◽  
The Impact

Abstract Abstract 2244 Background: Patients (pts) with MM are at increased risk for VTE due to various risk factors related to the host, disease, and treatment. Immunomodulatory drugs (IMiDs) such as thalidomide and lenalidomide have further increased the risk of VTE. Several studies have shown the VTE risk can be reduced with the use of low molecular weight heparin (LMWH) or aspirin thromboprophylaxis. Based on these findings, VTE thromboprophylaxis has been recommended in pts receiving IMiDs + Dexamethasone (Dex), but the impact of these guidelines on patient outcomes in clinical practice is unclear. The objective of this observational study was to evaluate the incidence, timing and risk factors of VTE and the impact of different types of thromboprophylaxis on the incidence of VTE. Methods: This was a retrospective cohort study, and included all MM pts newly referred to the M.D. Anderson Cancer Center in 2006. Medical records of these pts were reviewed for the type and site of VTE, the incidence and timing of VTE during the five-year period from the referral date, and the risk factors, including pt demographics, co-morbidities, baseline laboratory values, types of MM and treatment, and types of thromboprophylaxis. Univariate and multivariate proportional hazard models were fitted to find the independent risk factors predictive of VTE. The stepwise selection method was employed to build a multivariate model using variables with p<0.15 in univariate analysis. Results: The cumulative incidence of VTE was 24% (38/159 pts) during the 5-year follow up period. Of the 38 pts with VTE, 25 (66%) had deep vein thrombosis (DVT), 11 (29%) had pulmonary embolus (PE), and 2 had concurrent DVT and PE. Most of the pts (32/38, 84%) had VTE within 1 year from the referral date. The incidence of recurrent VTE among these pts was 27.5% (11/38 pts), for a total of 52 episodes. Since the majority of VTEs and recurrences were within one year, we examined the risk factors for VTE during this period. Treatment with IMiDs + Dex and thromboprophylaxis with LMWH or Coumadin were independent predictive factors as shown below. The incidence of VTE was highest in pts exposed to IMiDs + Dex (30/38 pts), even after discontinuation of treatment, with most episodes (17/30) occurring during the preparation (7/30) or within 30 days (10/30) following hematopoietic stem cell transplantation (HSCT), when most (16/17) pts were not receiving anti-coagulants. Conclusions: These findings suggest that patients treated with IMiDs + Dex are at high risk for VTE, even after discontinuation of this treatment, especially, during and after the HSCT period. Future studies are needed to investigate VTE prevention strategies for this high-risk pt population. Disclosures: No relevant conflicts of interest to declare.

scholarly journals 909. Reassessing Pathogens Eligible for the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) “Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infection” Criteria

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S488-S489
Author(s):  
Nora Chea ◽  
Shelley Magill ◽  
Andrea L Benin ◽  
Katherine Allen-Bridson ◽  
Margaret Dudeck ◽  
...  
Keyword(s):  
High Risk ◽  
Bloodstream Infection ◽  
Central Line ◽  
Low Risk ◽  
Mucosal Barrier ◽  
Absolute Difference ◽  
Candida Spp ◽  
Oncology Patients ◽  
Mucosal Barrier Injury ◽  
Medium Risk

Abstract Background NHSN Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infection (MBI-LCBI) includes pathogens likely to cause bloodstream infections (BSI) in some oncology patients. MBI-LCBIs are excluded from central line-associated BSI (CLABSI) reporting to the Centers for Medicare & Medicaid Services. NHSN users have requested other pathogens be added to MBI-LCBI. To make decision, we compared CLABSI pathogen distributions in three NHSN patient location groups. Methods We analyzed CLABSI data from hospitals conducting surveillance for ≥ 1 month from January 2014–December 2018 in ≥ 1 MBI high-risk location (leukemia, lymphoma, and adult and pediatric hematopoietic stem cell transplant wards). We compared CLABSI pathogen distributions and rates in MBI high-risk locations to medium-risk (solid tumor, adult and pediatric general hematology-oncology wards) and low-risk locations (adult and pediatric medical, surgical, and medical-surgical wards), and used χ2 tests to compare percentages with statistical significance at P ≤ 0.05. Results Overall, 122 hospitals reported 23,578 CLABSIs and 12,961,921 central line (CL)-days (1.81 CLABSIs per 1,000 CL-days) (Table). Percentages of CLABSIs due to three MBI-LCBI pathogens (E. coli, E. faecium, Viridans streptococci) were significantly higher in high- versus low-risk locations, while for other MBI-LCBI pathogens (K. pneumoniae/oxytoca, E. faecalis, Candida spp., Enterobacter spp.) percentages were significantly lower in high-risk locations (Figure). For pathogens not currently in MBI-LCBI, coagulase-negative staphylococci caused similar percentages of CLABSIs across locations, S. aureus caused a significantly higher percentage of CLABSIs in low-risk locations, while PA caused a significantly higher percentage of CLABSIs in high-risk locations. Table CLABSIs attributed to MBI high-risk, medium-risk, and low-risk locations, NHSN, 2014–2018 Figure Percentages of top 10 pathogen-specific CLABSIs in MBI high-risk, medium-risk, and low-risk locations, NHSN, 2014–2018 Conclusion Differences in percentages of CLABSIs due to selected pathogens between MBI high-risk and low-risk locations are evident in NHSN data. Lower percentages of Klebsiella and Candida spp. in high-risk locations might be partially due to antimicrobial prophylaxis in oncology patients. Although PA caused a significantly higher percentage of CLABSIs in high-risk locations, the absolute difference was modest. Additional analyses are needed. Disclosures All Authors: No reported disclosures

scholarly journals 502. The Impact of Combating COVID-19 on Blood Culture Contamination and Central Line Associated Bloodstream Infection Rates

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S316-S317
Author(s):  
Jennifer LeRose ◽  
Avnish Sandhu ◽  
Jordan Polistico ◽  
Joseph Ellsworth ◽  
Nancy Baran ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Tertiary Care ◽  
Time Frame ◽  
Central Line ◽  
Positive Patient ◽  
P Value ◽  
The Impact ◽  
Clabsi Rate

Abstract Background Coronavirus disease (COVID-19) pandemic has presented challenges to every facet of the healthcare system. There is limited research evaluating the consequence of diverting resources from patient safety initiatives to COVID-19 crisis efforts. In an attempt to quantify the impact of COVID-19 on quality of patient care, we compared rates of blood culture contamination and central line associated bloodstream infections (CLABSIs) during COVID-19 to those before the pandemic. Methods A comparative retrospective cohort study was conducted to analyze blood culture contamination and CLABSI rate per 1,000 line days in a tertiary care hospital in Detroit within a “pre- COVID-19” timeframe, January - May 2019, and “COVID-19” timeframe, January - May 2020. The CLABSI rate data was obtained through Infection Control Surveillance System TheraDoc®. Blood culture contamination report was obtained through the Microbiology Department. Chi-square and t-test were used for statistical analysis. Results The blood culture contamination rate increased from 3.1% during pre COVID-19 timeframe to 4.0% during COVID-19 (p-value &lt; 0.01) (Figure 1) with the highest rate in March and April 2020 correlating with the peak of COVID-19 (Figure 2). The CLABSI rate per 1,000 line days increased from 0.71 in pre-COVID-19 time frame to 2.70 during COVID-19 (p-value &lt; 0.01) (Figure 1). Of the 33 CLABSIs identified during the COVID-19 time frame, 18 (54%) patients tested positive for COVID-19. When comparing COVID-19 positive and COVID-19 negative patients; average length of stay was 28.1 days shorter in the positive group (p-value &lt; 0.01). COVID-19 positive patient had higher mortality (p-value &lt; 0.01) (Table1). Refer to Table 1 for comparison of variables between pre COVID-19 and COVID-19 cohort and COVID-19 positive and negative cohort. Figure 1. Rate of blood culture contamination (top) and CLABSI per 1,000 Line Days Rate (below) Between Two Study Period (Pre COVID-19 and COVID-19) Figure 2. Unique COVID Positive results in a Tertiary Care Center, Detroit, January-May 2020 Table 1. Characteristics of Entire Cohort Conclusion A 29% increase in blood culture contamination and 280% increase in CLABSI rate represents an enormous burden on healthcare resources and decreased quality. Despite no increase in length of stay in COVID-19 positive patient, higher mortality and CLABSIs were noted in these patients. During a pandemic, healthcare systems should be allocated additional resources to accommodate the increased patient load without affecting quality of care. Disclosures Teena Chopra, MD, MPH, Spero Therapeutics (Consultant, Advisor or Review Panel member)

scholarly journals 180. Duration of Therapy and Clinical Outcomes in Adult Oncology Patients with Uncomplicated Coagulase Negative Staphylococcal Bacteremia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S198-S199
Author(s):  
Amanda Fairbanks ◽  
Jessica Li ◽  
Ania Sweet ◽  
Frank Tverdek ◽  
Catherine Liu
Keyword(s):  
Blood Culture ◽  
Clinical Outcomes ◽  
Blood Cultures ◽  
Cancer Center ◽  
Cell Transplant ◽  
Inclusion Criteria ◽  
Negative Blood Culture ◽  
Duration Of Treatment ◽  
Hematopoietic Stem ◽  
Antibiotic Duration

Abstract Background Although they are often considered contaminants, coagulase negative staphylococci (CoNS) can be pathogens especially in immunocompromised patients. National and local guidelines recommend treatment durations of 7 to 14 days, depending on specific clinical scenarios. The objective was to characterize the duration of treatment for CoNS bacteremia and clinical outcomes at our cancer center. Methods We conducted a retrospective chart review of adult patients ≥18 years old with ≥1 blood culture with growth of CoNS between 1/1/17 and 12/31/19 at our cancer center. Patients with complicated CoNS bacteremia and polymicrobial infections were excluded. Results Among 128 patients identified during the study period, 98 met inclusion criteria (Figure 1). Most patients (N= 92; 94%) had a hematologic malignancy as the underlying oncologic diagnosis, and 68 (69%) were hematopoietic stem cell transplant recipients. The median total antibiotic duration was 13 days, and median duration from the date of 1st negative blood culture was 12 days; 29 (30%) patients were treated for a total duration of &gt;14 days (Figure 2). The catheter was retained in 67 (68%) and exchanged in 4 (4%) of the cases. Three (3%) patients had recurrence of bacteremia within 30 days of treatment completion, and 8 (8%) patients were transferred to the ICU within 7 days of the index blood culture. The 30-day crude mortality rate was 10%. The most commonly used antibiotic for treatment was vancomycin (N= 95; 97%), and 32 (34%) patients on vancomycin had an increase in serum creatinine of ≥ 50% from baseline. Five (5%) patients discontinued vancomycin due to nephrotoxicity, and 4 (4%) patients required hemodialysis. Figure 1. Results Overview Among 128 patients identified during the study period, 98 met inclusion criteria. Of those included, 36 had one set of blood cultures that were positive for CoNS and 62 patients had at least two sets of blood cultures that were positive for CoNS. Figure 2. Duration of Antibiotic Treatment We evaluated duration of treatment based on total antibiotic duration and duration from date of 1st negative blood culture. The number of patients is noted above each bar. Conclusion Although the majority of patients were treated for ≤14 days for uncomplicated CoNS bacteremia, nearly 1/3 of patients were treated for &gt; 14 days. Recurrent bacteremia was uncommon despite catheter retention in most patients. Relatively high rates of vancomycin associated nephrotoxicity highlight opportunities for antimicrobial stewardship to limit duration of vancomycin therapy among cancer patients with uncomplicated CoNS bacteremia. Disclosures All Authors: No reported disclosures

scholarly journals 770. Impact of COVID-19 Pandemic on Central Line-associated Bloodstream Infections in Metropolitan Detroit

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S482-S482
Author(s):  
Geehan Suleyman ◽  
Nicholas sturla ◽  
Smitha Gudipati ◽  
Indira Brar ◽  
Ramesh Mayur
Keyword(s):  
Blood Culture ◽  
Control Chart ◽  
Tertiary Care ◽  
Central Line ◽  
Utilization Rate ◽  
P Value ◽  
Care Hospital ◽  
Cross Sectional ◽  
The Impact ◽  
Clabsi Rate

Abstract Background Recent publications suggest that central line-associated bloodstream infection (CLABSI) rates have increased in US hospitals during the COVID-19 pandemic. The objective of this study was to evaluate the impact of COVID-19 pandemic on CLABSIs. Methods This was a retrospective cross-sectional study comparing CLABSI rate per 1,000 central line (CL) days, blood culture (BC) utilization rate per 1,000 CL days, CL utilization rate per 1,000 patient days, Standardized Infection Ratio (SIR) and Standardized Utilization Ratio (SUR) in the pre-COVID-19 period from January 1, 2019 to December 31, 2019 to the COVID-19 period from April 1, 2020 to March 31, 2021 at an 877-bed tertiary care hospital in Detroit, Michigan. CLABSI, and BC and CL utilization rate were extracted from the electronic medical record (Epic™ Bugsy). SIR and SUR data were extracted from National Healthcare Safety Network (NHSN). Results The average CLABSI rate per 1,000 CL days increased 24% from 1.66 to 2.06. Twenty percent of patients were hospitalized for COVID-19. The BC utilization rate per 1,000 CL days decreased from 0.43 to 0.32 with a 26% reduction. However, CL utilization increased by 28% from 0.25 to 0.32 (Figure 1). However, CLABSIs due to common commensals decreased from 13.8% to 10.9%. The SIR increased significantly from 1.055 to 1.795 (P-value 0.008), resulting in a 70% increase. The overall SUR also increased from 0.900 to 0.988 (P-value &lt; 0.001). Figure 2 is a control chart of the CLABSI rate from July 2019 to April 2021. Figure 1. CLABSI, blood culture utilization and central line utilization rates pre-and during COVID-19 pandemic Figure 2. CLABSI control chart pre-and during COVID-19 pandemic Conclusion During the COVID-19 pandemic, there was a significant increase in CL utilization, CLABSI rate, SIR and SUR likely due to higher acuity in COVID-19 patients despite a decrease in BC orders. Disclosures All Authors: No reported disclosures

Inpatient Antibiotic Stewardship Interventions in the Adult Oncology and Hematopoietic Stem Cell Transplant Population: A Review of the Literature

2019 ◽  
Vol 54 (6) ◽  
pp. 594-610 ◽  
Author(s):  
Kelly E. Pillinger ◽  
Jeannette Bouchard ◽  
Sarah T. Withers ◽  
Krutika Mediwala ◽  
Edoabasi U. McGee ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Antibiotic Stewardship ◽  
Clinical Pathways ◽  
Audit And Feedback ◽  
Quality Data ◽  
Cell Transplant ◽  
Negative Consequences ◽  
Oncology Patients ◽  
Hematopoietic Stem ◽  
The Impact

Objective: To review the use of antibiotic stewardship interventions in the adult oncology and hematopoietic cell transplantation (HCT) populations. Data Sources: A literature search of PubMed was performed from inception to October 31, 2019. The general search terms used were oncology, cancer, hematologic malignancy, antimicrobial stewardship, antibiotic stewardship, febrile neutropenia, neutropenic fever, de-escalation, discontinuation, prophylaxis, practice guidelines, clinical pathway, rapid diagnostics, Filmarray, Verigene, MALDI-TOF, antibiotic allergy, and antimicrobial resistance. Study Selection and Data Extraction: Relevant English-language studies describing interventions supported by the Infectious Diseases Society of America guidelines on “Implementing an Antibiotic Stewardship Program” were included. Data Synthesis: Antibiotic stewardship publications in the oncology population have increased in recent years. Studies have described the impact of stewardship interventions, including preauthorization, prospective audit and feedback, implementation of clinical pathways, de-escalation of empirical antibiotics for febrile neutropenia (FN) prior to neutrophil recovery, allergy assessments, and use of rapid diagnostic testing. Many of these interventions have been shown to decrease antibiotic use without increased negative consequences, such as affecting length of stay or mortality. Relevance to Patient Care and Clinical Practice: This review synthesizes available evidence for implementing antibiotic stewardship interventions, particularly de-escalation of antibiotics for FN and implementation of clinical pathways for FN and sepsis, in oncology patients and HCT recipients. Summary tables highlight studies and specific research needs for clinicians. Conclusions: Immunocompromised populations, including oncology patients, have often been excluded from stewardship studies. Antibiotic stewardship is effective in reducing antibiotic consumption and improving outcomes in this patient population, although more quality data are needed.

scholarly journals Hematopoietic Stem Cell Transplant for Hematological Malignancies: Experience from a Tertiary Care Center in Northern India and Review of Indian Data

2021 ◽  
Author(s):  
Sanjeev Kumar Sharma ◽  
Dharma Choudhary ◽  
Divya Doval ◽  
Vipin Khandelwal ◽  
Rasika Setia ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Hematopoietic Stem Cell ◽  
Hematological Malignancies ◽  
Care Center ◽  
Tertiary Care ◽  
Disease Free Survival ◽  
Cell Transplant ◽  
Real World Data ◽  
Hematopoietic Stem

AbstractHematopoietic stem cell transplantation (HSCT) is the preferred treatment for high-risk and relapsed/refractory hematological malignancies. Moreover, with the improved supportive care and increasing acceptance of haploidentical transplantations as an alternative treatment modality, more patients are opting for HSCT as a definite treatment for hematological malignancies. We report here the real-world data and outcome of HSCT done for hematological malignancies at our transplant center. Five hundred and sixteen patients underwent HSCT from August 2010 to November 2019. The most common indications for allogeneic and autologous HSCT were acute myeloid leukemia and multiple myeloma, respectively. The 5-year overall survival and disease-free survival for all transplants were 65% and 33%, respectively. Though outcome of matched sibling donor allogeneic transplant is better than haploidentical donor (HID) transplant, patients having only HID can still be considered for allogeneic HSCT for high-risk diseases. The most common cause of death was infections followed by relapse of the disease.

Gemtuzumab Ozogamicin Improves Event-Free Survival and Reduces Relapse in Pediatric KMT2A-Rearranged AML: Results From the Phase III Children's Oncology Group Trial AAML0531

2021 ◽  
pp. JCO.20.03048
Author(s):  
Jessica A. Pollard ◽  
Erin Guest ◽  
Todd A. Alonzo ◽  
Robert B. Gerbing ◽  
Mike R. Loken ◽  
...  
Keyword(s):  
High Risk ◽  
Gemtuzumab Ozogamicin ◽  
Phase Iii ◽  
Cell Transplant ◽  
Oncology Group ◽  
Event Free Survival ◽  
Hematopoietic Stem ◽  
Free Survival ◽  
The Impact ◽  
Group Trial

PURPOSE We investigated the impact of the CD33-targeted agent gemtuzumab ozogamicin (GO) on survival in pediatric patients with KMT2A-rearranged ( KMT2A-r) acute myeloid leukemia (AML) enrolled in the Children's Oncology Group trial AAML0531 ( NCT01407757 ). METHODS Patients with KMT2A-r AML were identified and clinical characteristics described. Five-year overall survival (OS), event-free survival (EFS), disease-free survival (DFS), and relapse risk (RR) were determined overall and for higher-risk versus not high-risk translocation partners. GO's impact on response was determined and outcomes based on consolidation approach (hematopoietic stem cell transplant [HSCT] v chemotherapy) described. RESULTS Two hundred fifteen (21%) of 1,022 patients enrolled had KMT2A-r AML. Five-year EFS and OS from study entry were 38% and 58%, respectively. EFS was superior with GO treatment (EFS 48% with GO v 29% without, P = .003), although OS was comparable (63% v 53%, P = .054). For patients with KMT2A-r AML who achieved complete remission, GO was associated with lower RR (40% GO v 66% patients who did not receive GO [No-GO], P = .001) and improved 5-year DFS (GO 57% v No-GO 33%, P = .002). GO benefit was observed in both higher-risk and not high-risk KMT2A-r subsets. For patients who underwent HSCT, prior GO exposure was associated with decreased relapse (5-year RR: 28% GO and HSCT v 73% No-GO and HSCT, P = .006). In multivariable analysis, GO was independently associated with improved EFS, improved DFS, and reduced RR. CONCLUSION GO added to conventional chemotherapy improved outcomes for KMT2A-r AML; consolidation with HSCT may further enhance outcomes. Future clinical trials should study CD33-targeted agents in combination with HSCT for pediatric KMT2A-r AML.

scholarly journals Effect of Early Post-Transplantation Tacrolimus Concentration on the Risk of Acute Graft-Versus-Host Disease in Allogenic Stem Cell Transplantation

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 613
Author(s):  
Nidhi Sharma ◽  
Qiuhong Zhao ◽  
Bin Ni ◽  
Patrick Elder ◽  
Marcin Puto ◽  
...  
Keyword(s):  
Stem Cell ◽  
Graft Versus Host Disease ◽  
Tacrolimus Concentration ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Host Disease ◽  
Graft Versus Host ◽  
The Impact ◽  
Risk Of Relapse ◽  
Acute Graft

Acute graft versus host disease (aGVHD) remains a leading cause of morbidity and mortality in allogeneic hematopoietic stem cell transplant (allo-HSCT). Tacrolimus (TAC), a calcineurin inhibitor that prevents T-cell activation, is commonly used as a GVHD prophylaxis. However, there is variability in the serum concentrations of TAC, and little is known on the impact of early TAC levels on aGVHD. We retrospectively analyzed 673 consecutive patients undergoing allo-HSCT at the Ohio State University between 2002 and 2016. Week 1 TAC was associated with a lower risk of aGVHD II–IV at TAC level ≥10.15 ng/mL (p = 0.03) compared to the lowest quartile. The cumulative incidence of relapse at 1, 3 and 5 years was 33%, 38% and 41%, respectively. TAC levels at week 2, ≥11.55 ng/mL, were associated with an increased risk of relapse (p = 0.01) compared to the lowest quartile. Subset analysis with acute myeloid leukemia and myelodysplastic syndrome patients showed significantly reduced aGVHD with TAC level ≥10.15 ng/mL at week 1 and a higher risk of relapse associated with week 2 TAC level ≥11.55 ng/mL (p = 0.02). Hence, achieving ≥10 ng/mL during the first week of HCT may mitigate the risk of aGVHD. However, levels (>11 ng/mL) beyond the first week may be associated with suppressed graft versus tumor effect and higher relapse.

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