scholarly journals Risk factors for fatal infectious complications developing late after allogeneic stem cell transplantation

2007 ◽  
Vol 40 (11) ◽  
pp. 1055-1062 ◽  
Author(s):  
A Bjorklund ◽  
J Aschan ◽  
M Labopin ◽  
M Remberger ◽  
O Ringden ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Infectious Complications

Fatal Infectious Complications Developing Late after Allogeneic Stem Cell Transplantation.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3239-3239
Author(s):  
Andreas Bjorklund ◽  
Johan Aschan ◽  
Olle Ringden ◽  
Jacek H. Winiarski ◽  
Per T. Ljungman
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Chronic Gvhd ◽  
Infectious Complications ◽  
Control Group ◽  
Cmv Infection ◽  
Respiratory Dysfunction

Abstract Background and aim: The procedure of allogeneic stem cell transplantation (SCT) has evolved during the past decades. Infectious complications are still a major problem contributing to the transplantation related mortality (TRM). The epidemiology and outcome of early infections after SCT are well described. However, less is known has about late infections after SCT. Thus, the aim of this study was to determine risk factors for fatal infections occurring later than 6 months after allogeneic SCT. Material and methods: Our study is based on 938 consecutive SCT patients transplanted 1976–2003 of whom 688 (73%) had survived for at least 6 months after SCT. A retrospective chart review was performed identifying 44 (6.4%) patients surviving for at least 6 months, having died from infection. Patients who had relapsed in their malignant disease were excluded. A control group of 176 patients (4 per case) was identified using relapse-free survival for at least 6 months and year of SCT as the matching criteria. Five controls were excluded leaving 171 patients in the control population. Risk factors for death from late infections were identified by logistic regression. Results: 29 patients (66%) developed their fatal infection within 18 months and 37 (84%) within 5 years after SCT. 37 patients (84%) had ongoing chronic graft versus host disease (GVHD) and 36/44 (82%) had ongoing immunosupression at the time of death. 57 controls had died after 6 months from SCT; 32 of 57 from relapse. Comparing patients and controls in univariate analyses, the mean age was 30.6 years in the cases and 26.5 years in the controls (p=.13). 22/44 (50%) cases had been transplanted from an unrelated or mismatched donor, compared to 57/171 (33%) controls, p=.053; and 35/44 (80%) cases had received a conditioning regimen including myeloablative dose of TBI compared to 113/171 (66%) in the control group, p<.05). Regarding post-transplant complications 40/44 (91%) cases had experienced cGVHD compared with 101/171 (59%) controls, p<.001. 21/44 (48%) cases had developed obstructive respiratory dysfunction compared with 46/171 (27%) controls, p=.01; and more cases (33/44; 75%) than controls (85/171; 50%;) had experienced CMV infection. In multivariate analysis chronic GVHD (OR 9.2; p<.001), use of a mismatched or unrelated donor (OR 4.8; p<.001), and having had a CMV reactivation (OR 8.3; p=.004) increased the risk. Age, acute GVHD, TBI or obstructive respiratory dysfunction had no significant impact on the risk for late fatal infection. Conclusion: Infections later than 6 months after SCT are important contributors to late TRM. Risk factors for late fatal infections include chronic GVHD, use of alternative donors and CMV infection.

scholarly journals Prolonged immune deficiency following allogeneic stem cell transplantation: risk factors and complications in adult patients

2001 ◽  
Vol 115 (3) ◽  
pp. 630-641 ◽  
Author(s):  
Sébastien Maury ◽  
Jean-Yves Mary ◽  
Claire Rabian ◽  
Michael Schwarzinger ◽  
Antoine Toubert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Immune Deficiency ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Adult Patients

Delayed Platelet Recovery After Allogeneic Peripheral Blood, Marrow and Umbilical Cord Stem Cell Transplantation: Risk Factors and Clinical Outcomes.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 867-867
Author(s):  
Pablo A Ramirez ◽  
Claudio Brunstein ◽  
Brian Miller ◽  
Todd E. DeFor ◽  
Daniel J. Weisdorf
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Peripheral Blood ◽  
Myeloablative Conditioning ◽  
Platelet Recovery ◽  
Donor Type ◽  
Associated Risk Factors

Abstract Abstract 867 Introduction: Several reports have shown that despite prompt neutrophil engraftment after allogeneic stem cell transplantation, there can be delayed platelet recovery, especially in umbilical cord blood (UCB) stem cell transplant recipients. This dichotomy in platelets and neutrophils engraftment is poorly explained. In addition, the risk factors and complications associated with delayed platelet recovery are not clearly identified. Methods: We conducted a retrospective analysis to characterize the frequency of delayed platelet recovery and its associated risk factors and related complications. All allografts at the University of Minnesota between 2000 and 2005 were included. Results: 875 patients with hematologic malignancies or benign disorders were included. Myeloablative conditioning was used in 576 (66%) patients and non-myeloablative conditioning in 299 (34%) patients. 343 (39%) patients received related donor and 532 (61%) unrelated grafts. The source of the graft was bone marrow in 226 (26%) patients, peripheral blood in 255 (29%) patients and UCB in 394 (45%) patients. 150 (17%) patients were excluded due to early death (n=87, 10%), graft failure (n=62, 7%) and second transplant without engraftment (n=1). The 60 day cumulative incidence of platelet recovery by donor type was UCB single cord 39% (n=180, CI 31-47%), UCB double cord 40% (n=206, CI 32-48%), URD mismatched 57% (n=28, CI 39-75%), URD matched 56% (n=117, 48-64%) and sibling 74% (n=319, 65-85%). Overall, 232 (32%) had delayed platelet recovery (platelets<50K by day 60) and 475 (67%) had successful recovery (platelets>50K by day 60). Cox regression analysis showed that variables significantly associated with delayed platelet recovery were donor type (UCB RR 0.3 [CI 0.2-0.35], p<0.01 vs sibling RR 1.0), ABO match (major mismatch RR 0.8 [CI 0.6-1.0], p<0.01 vs matched RR 1.0), CMV status (positive RR 0.8 [CI 0.6-1.0], p=0.04 vs negative RR 1.0) and the vs negative RR 1.0). Transplant related mortality (TRM) at 12 months was also higher in patients with delayed platelet recovery compared to patients with successful platelet recovery (30% vs 11%) (p<0.01). Risk factors for TRM by proportional hazard regression were delayed platelet engraftment (RR 3.9 [2.6-6.0], p=<0.01 vs early RR 1.0), HLA mismatched unrelated donor (RR 3.7 [CI 2.5-7.1], p=0.01 vs sibling RR 1.0), severe aGVHD (RR 1.8 [CI 1.2-2.8], p=0.02 vs no severe RR 1.0) and age > 35 (RR 1.6 [CI 1.0-2.5], p=0.03 vs age < 35 RR 1.0). Successful platelet recovery was associated with a 77% 1 year survival versus only 59% in patients with delayed platelet recovery (p<0.01). Conclusions: These results suggest that delayed platelet recovery and poor graft function are common complications of allogeneic stem cell transplantation, especially after UCB grafts. Further study is needed to determine if modification of these associated risk factors will reduce the risks of severe complications and improve survival. Disclosures: No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document