Miller Holly K, Braun Thomas M, Stillwell Terri, Harris Andrew C, Choi Sung, Connelly James, Couriel Daniel, Goldstein Steven, Kitko Carrie L, Magenau John, Pawarode Attaphol, Reddy Pavan, Riwes Mary, Yanik Gregory A, Levine John E
Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, Michigan; Pediatric Hematology/Oncology, Phoenix Children's Hospital, Phoenix, Arizona.
School of Public Health, University of Michigan, Ann Arbor, Michigan.
Biol Blood Marrow Transplant. 2017 Mar;23(3):522-528. doi: 10.1016/j.bbmt.2016.12.630. Epub 2016 Dec 22.
The occurrence of infections after allogeneic hematopoietic stem cell transplantation (HCT) is nearly universal. However, the relationship between infections and graft-versus-host disease (GVHD) is complex and attribution of infectious-related mortality is highly inconsistent, making comparison of infectious complication rates across allogeneic HCT clinical studies difficult. We categorized infectious complications from diagnosis or 1 year before HCT (whichever occurred later) through 2 years after HCT according to timing, frequency, causative organism, severity, and contribution to mortality for 431 consecutive patients who underwent allogeneic HCT from 2008 to 2011. We then assessed the contribution of risk factors, such as the frequency of pre-HCT infections and post-HCT GVHD, on post-HCT infection frequency and severity. We found that each pre-HCT bacterial infection/year leads to an additional 2.15 post-HCT bacterial infection/year (P = .004). Pre-HCT viral and fungal infections were not predictors for post-HCT infections. Acute GVHD (aGVHD) significantly increased the risk of developing life-threatening (hazard ratio [HR], 1.97; 95% confidence interval [CI], 1.33 to 2.90) and fatal (HR, 2.8; 95% CI, 1.10 to 7.08) infections. Furthermore, patients who develop aGVHD experienced ~60% more infections than patients who never develop aGVHD. Quantification of infection frequency and severity for patients with and without GVHD may facilitate comparison of infectious outcomes across allogeneic HCT trials.
异基因造血干细胞移植（HCT）后感染几乎普遍发生。然而，感染与移植物抗宿主病（GVHD）之间的关系复杂，且感染相关死亡率的归因高度不一致，这使得比较异基因HCT临床研究中的感染并发症发生率变得困难。我们根据时间、频率、致病微生物、严重程度以及对死亡率的影响，对2008年至2011年连续接受异基因HCT的431例患者从HCT诊断时或HCT前1年（以较晚者为准）至HCT后2年的感染并发症进行了分类。然后，我们评估了HCT前感染频率和HCT后GVHD等风险因素对HCT后感染频率和严重程度的影响。我们发现，HCT前每年发生一次细菌感染会导致HCT后每年额外发生2.15次细菌感染（P = 0.004）。HCT前的病毒和真菌感染不是HCT后感染的预测因素。急性GVHD（aGVHD）显著增加了发生危及生命（风险比[HR]，1.97；95%置信区间[CI]，1.33至2.90）和致命（HR，2.8；95%CI，1.10至7.08）感染的风险。此外，发生aGVHD的患者比从未发生aGVHD的患者感染次数多约60%。对有或无GVHD患者的感染频率和严重程度进行量化，可能有助于比较异基因HCT试验中的感染结果。
