Department of Hematology and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.
University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.
Cancer. 2018 Jan 15;124(2):286-296. doi: 10.1002/cncr.31045. Epub 2017 Sep 28.
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative treatment option for patients with acute myeloid leukemia (AML). During transplantation, patients undergo a period of severe neutropenia, which puts them at high risk for infectious complications. However, the impact of patient colonization with multidrug-resistant organisms (MDRO) on overall survival remains unclear.
In this retrospective, single-center study, the authors analyzed data from 264 patients with AML who underwent a first allo-HSCT between January 2006 and March 2016 at their institution. Primary endpoints were overall survival and nonrelapse-related mortality.
One hundred forty-two of 264 patients (53.8%) were colonized by at least 1 MDRO, mainly with vancomycin-resistant Enterococcus faecalis/faecium (n = 122). The characteristics of colonized patients did not differ from those of MDRO-negative patients with respect to median age (53.5 vs 53 years), cytogenetic risk according to European LeukemiaNet criteria, remission status before allo-HSCT (first or second complete remission: 55.7% vs 60.7%, respectively; active disease: 44.4% vs 39.3%, respectively), donor type, or hematopoietic cell transplantation-comorbidity index (HCT-CI). Compared with noncolonized patients, MDRO-positive patients had an inferior probability of survival at 5 years (43.3% vs 65.5%; P = .002), primarily because of a higher cumulative incidence of nonrelapse-related mortality (33.9% vs 9.4%; P < .001). Death caused by infections occurred in 15.5% of colonized patients versus 4.9% of noncolonized patients. There was no difference in the cumulative incidence of relapse in MDRO-positive versus MDRO-negative patients (33.8% vs 42.1%, respectively; P = .798).
The current data emphasize the importance of regular MDRO screenings and prompt further investigations into the impact of colonization with MDRO on the immune system after allo-HSCT. Cancer 2018;124:286-96. © 2017 American Cancer Society.
异基因造血干细胞移植（allo-HSCT）是急性髓系白血病（AML）患者的一种根治性治疗选择。在移植过程中，患者会经历严重的中性粒细胞减少期，因此面临感染并发症的高风险。然而，患者是否定植了多重耐药菌（MDRO）对总生存的影响尚不清楚。
在这项回顾性单中心研究中，作者分析了 2006 年 1 月至 2016 年 3 月期间在其机构接受首次 allo-HSCT 的 264 例 AML 患者的数据。主要终点是总生存和非复发相关死亡率。
264 例患者中有 142 例（53.8%）定植了至少 1 种 MDRO，主要是耐万古霉素的粪肠球菌/屎肠球菌（n = 122）。定植患者的特征与 MDRO 阴性患者相比，中位年龄（53.5 岁比 53 岁）、根据欧洲白血病网标准的细胞遗传学风险、allo-HSCT 前的缓解状态（完全缓解 1 或 2 次：分别为 55.7%比 60.7%；活动疾病：分别为 44.4%比 39.3%）、供者类型或造血细胞移植合并症指数（HCT-CI）无差异。与非定植患者相比，MDRO 阳性患者 5 年生存率较低（43.3%比 65.5%；P =.002），主要是由于非复发相关死亡率的累积发生率较高（33.9%比 9.4%；P <.001）。感染导致的死亡发生在 15.5%的定植患者中，而在 4.9%的非定植患者中。MDRO 阳性与 MDRO 阴性患者的累积复发率无差异（分别为 33.8%和 42.1%；P =.798）。
目前的数据强调了定期进行 MDRO 筛查的重要性，并需要进一步研究 MDRO 定植对 allo-HSCT 后免疫系统的影响。癌症 2018；124：286-96。©2017 美国癌症协会。
