Cellular Therapy and Immunology, Manashi Chakrabarti Foundation, Kolkata, India; Department of Blood and Marrow Transplantation, Dharamshila Narayana Superspeciality Hospital, New Delhi, India.
Cellular Therapy and Immunology, Manashi Chakrabarti Foundation, Kolkata, India; Department of Blood and Marrow Transplantation, Dharamshila Narayana Superspeciality Hospital, New Delhi, India.
Biol Blood Marrow Transplant. 2019 Aug;25(8):1621-1628. doi: 10.1016/j.bbmt.2019.04.023. Epub 2019 May 22.
We prospectively studied the impact of preemptive granulocyte infusions (pGIs) in 69 patients colonized with carbapenem-resistant gram-negative bacteria (CRGNB) undergoing haploidentical hematopoietic cell transplantation (HCT) compared with a previous cohort of 33 patients who received only antimicrobials directed toward CRGNB at the onset of neutropenic fever (non-pGI group). All patients developed neutropenic fever at a median of day +8 (range, -4 to +12) after transplantation. Engraftment kinetics were similar for both groups. The median number of GIs was 2 (range, 1 to 7), and the median dose of granulocytes infused was 5 × 10 granulocytes per infusion (range, 1 to 30). The overall incidence of CRGNB bloodstream infections (BSIs) was 21.2% in non-pGI group (7/33) and 17.5% (12/69) in the pGI group (P = .8). However, the CRGNB-related mortality among those with BSI was 100% (7/7) in the non-pGI group versus 16.6% (2/12) in the pGI group (P = .001). The day 100 (4.4% versus 24.4%, P = .002) and 2-year nonrelapse mortality (7.5% versus 35.6%, P = .0001) were significantly reduced in the pGI group. The overall survival at 2 years was 75.6% in the pGI group versus 21.2% in the non-pGI group (P = .0001). Colonization and subsequent BSI with CRGNB are associated with a high incidence of mortality in patients undergoing HCT. pGI reduced early mortality associated with CRGNB in colonized patients undergoing post-transplant cyclophosphamide-based haploidentical HCT.
我们前瞻性地研究了 69 例定植有碳青霉烯类耐药革兰氏阴性菌（CRGNB）的患者在接受半相合造血细胞移植（HCT）时接受抢先性粒细胞输注（pGI）的影响，与之前仅在中性粒细胞减少性发热时接受针对 CRGNB 的抗生素治疗的 33 例患者（非 pGI 组）进行比较。所有患者在移植后第 8 天（范围为-4 至+12）中位数时出现中性粒细胞减少性发热。两组的植入动力学相似。两组的粒细胞输注中位数分别为 2 次（范围为 1 至 7 次），输注的粒细胞中位数剂量为 5×10 个粒细胞/次（范围为 1 至 30 个）。非 pGI 组 CRGNB 血流感染（BSI）的总体发生率为 21.2%（7/33），pGI 组为 17.5%（12/69）（P=0.8）。然而，非 pGI 组中发生 BSI 的 CRGNB 相关死亡率为 100%（7/7），pGI 组为 16.6%（2/12）（P=0.001）。pGI 组第 100 天（4.4%比 24.4%，P=0.002）和 2 年非复发死亡率（7.5%比 35.6%，P=0.0001）显著降低。pGI 组 2 年总生存率为 75.6%，而非 pGI 组为 21.2%（P=0.0001）。在接受 HCT 的患者中，CRGNB 的定植和随后的 BSI 与高死亡率相关。在接受移植后环磷酰胺为基础的半相合 HCT 的定植患者中，pGI 降低了与 CRGNB 相关的早期死亡率。
