单倍体造血干细胞移植后植入前血流感染的发生率、危险因素、微生物学和结局及与 HLA 同胞供者移植的比较。
Incidence, Risk Factors, Microbiology and Outcomes of Pre-engraftment Bloodstream Infection After Haploidentical Hematopoietic Stem Cell Transplantation and Comparison With HLA-identical Sibling Transplantation.
机构信息
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, China.
出版信息
Clin Infect Dis. 2018 Nov 13;67(suppl_2):S162-S173. doi: 10.1093/cid/ciy658.
BACKGROUND
Bloodstream infection (BSI) is a common and serious complication after hematopoietic stem cell transplantation (HSCT). An investigation of the characteristics of pre-engraftment BSI after haploidentical HSCT compared with human leukocyte antigen (HLA)-identical sibling HSCT has not been conducted.
METHODS
A single-center cohort representing 1847 consecutive patients undergoing haploidentical or HLA-identical sibling HSCT from 2013 to 2016 was selected. We investigated the characteristics of pre-engraftment BSI after haploidentical HSCT and its impact on patient outcome, and we compared it with HLA-identical sibling HSCT.
RESULTS
After haploidentical HSCT, the cumulative incidence of pre-engraftment BSI was higher (30-day: 9.2% [7.6, 10.8] vs 1.7% [0.5, 2.9], P < .0001) and median onset of BSI was earlier (day +3 vs day +9, P = .001) than HLA-identical sibling HSCT. Escherichia coli, Klebsiella pneumoniae, and coagulase-negative staphylococci were the most common isolates after haploidentical HSCT. However, Enterococcus faecium was the most common isolate after HLA-identical sibling HSCT. A multivariate analysis suggested that variables associated with BSI after haploidentical HSCT included a diagnosis of myelodysplastic syndrome (MDS), an interval from diagnosis to HSCT ≥190 days, carbapenem therapy, and grade 3-4 intestinal mucositis. The same variables, except MDS, were also associated with BSI after HLA-identical sibling HSCT. The multivariate analysis also suggested that BSI was a risk factor for increased all-cause mortality at 3 months after haploidentical HSCT (hazard ratio = 2.281; 95% confidence interval: 1.334, 3.900; P = .003).
CONCLUSIONS
Pre-engraftment BSI was more common after haploidentical HSCT than HLA-identical sibling HSCT. It was an independent factor associated with increased all-cause mortality at 3 months after haploidentical HSCT.
背景
造血干细胞移植（HSCT）后血流感染（BSI）是一种常见且严重的并发症。目前尚未对单倍体 HSCT 与人类白细胞抗原（HLA）-同基因兄弟姐妹 HSCT 后植入前 BSI 的特征进行研究。
方法
本研究选取了 2013 年至 2016 年期间在单中心接受单倍体或 HLA-同基因兄弟姐妹 HSCT 的 1847 例连续患者的队列。我们研究了单倍体 HSCT 后植入前 BSI 的特征及其对患者预后的影响，并与 HLA-同基因兄弟姐妹 HSCT 进行了比较。
结果
与 HLA-同基因兄弟姐妹 HSCT 相比，单倍体 HSCT 后植入前 BSI 的累积发生率更高（30 天：9.2%[7.6%，10.8%] vs. 1.7%[0.5%，2.9%]，P<.0001），且 BSI 的中位发病时间更早（第 3 天 vs. 第 9 天，P=.001）。单倍体 HSCT 后最常见的分离株为大肠埃希菌、肺炎克雷伯菌和凝固酶阴性葡萄球菌，而 HLA-同基因兄弟姐妹 HSCT 后最常见的分离株为屎肠球菌。多变量分析表明，与单倍体 HSCT 后 BSI 相关的变量包括骨髓增生异常综合征（MDS）诊断、HSCT 前诊断至 HSCT 的时间间隔≥190 天、碳青霉烯类药物治疗和 3-4 级肠道粘膜炎。除 MDS 外，与 HLA-同基因兄弟姐妹 HSCT 后 BSI 相关的变量也是相同的。多变量分析还表明，BSI 是单倍体 HSCT 后 3 个月全因死亡率增加的危险因素（危险比=2.281；95%置信区间：1.334，3.900；P=.003）。
结论
与 HLA-同基因兄弟姐妹 HSCT 相比，单倍体 HSCT 后植入前 BSI 更为常见。它是单倍体 HSCT 后 3 个月全因死亡率增加的独立危险因素。
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