Department of Pediatrics, Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Department of Population Sciences, City of Hope, Duarte, CA, USA.
Cancer Med. 2021 May;10(9):2956-2966. doi: 10.1002/cam4.3896. Epub 2021 Apr 9.
There is a paucity of studies describing the incidence and risk factors for late-occurring (≥1 year) infectious complications in contemporary survivors of hematopoietic cell transplantation (HCT).
This was a retrospective cohort study of 641 1-year survivors of HCT, transplanted between 2010 and 2013 as adults, and in remission from their primary disease. Standardized definitions were used to characterize viral, fungal, and bacterial infections. Cumulative incidence of infections was calculated, with relapse/progression considered as a competing risk event. Fine-Gray subdistribution hazard ratio estimates and 95% confidence intervals (CI) were obtained, adjusted for relevant covariates.
Median age at HCT was 55.2 years (range 18.1-78.1 years); 54.0% were survivors of allogeneic HCT. The 5-year cumulative incidence of a late-occurring infection for the entire cohort was 31.6%; the incidence of polymicrobial (≥2) infections was 10.1%. In survivors who developed at least one infection, the 5-year incidence of a subsequent infection was 45.3%. Among allogeneic HCT survivors, patients with acute lymphoblastic (HR = 1.82 95% CI [1.12-2.96]) or myeloid (HR = 1.50 95% CI [1.02-2.20]) leukemia, and those with an elevated HCT-Comorbidity index score (HR = 1.09 95% CI [1.01-1.17]) were more likely to develop late-occurring infections; there was an incremental risk associated with severity of graft versus host disease (GVHD) at 1-year post-HCT (mild: HR = 2.17, 95% CI [1.09-4.33]; moderate/severe: HR = 3.78, 95% CI [1.90-7.53]; reference: no GVHD).
The burden of late-occurring infections in HCT survivors is substantial, and there are important patient- and HCT-related modifiers of risk over time. These findings may help guide personalized screening and prevention strategies to improve outcomes after HCT.
目前缺乏研究描述当代造血细胞移植（HCT）后幸存者中迟发性（≥1 年）感染并发症的发生率和危险因素。
这是一项对 641 名 1 年 HCT 幸存者的回顾性队列研究，他们于 2010 年至 2013 年间接受移植，且处于原发性疾病缓解期。使用标准化定义来描述病毒、真菌和细菌感染。计算感染的累积发生率，将复发/进展视为竞争风险事件。采用 Fine-Gray 亚分布风险比估计值和 95%置信区间（CI），并根据相关协变量进行调整。
HCT 时的中位年龄为 55.2 岁（范围 18.1-78.1 岁）；54.0%为异基因 HCT 幸存者。整个队列的 5 年迟发性感染累积发生率为 31.6%；多微生物（≥2）感染的发生率为 10.1%。在发生至少一次感染的幸存者中，5 年后续感染的发生率为 45.3%。在异基因 HCT 幸存者中，患有急性淋巴细胞白血病（HR=1.82 95%CI[1.12-2.96]）或髓系白血病（HR=1.50 95%CI[1.02-2.20]）、以及具有较高 HCT 合并症指数评分（HR=1.09 95%CI[1.01-1.17]）的患者更有可能发生迟发性感染；随着 1 年后移植物抗宿主病（GVHD）严重程度的增加，风险也会增加（轻度：HR=2.17，95%CI[1.09-4.33]；中度/重度：HR=3.78，95%CI[1.90-7.53]；参考：无 GVHD）。
HCT 幸存者中迟发性感染的负担很大，随着时间的推移，患者和 HCT 相关因素对风险有重要的修饰作用。这些发现可能有助于指导个性化的筛查和预防策略，以改善 HCT 后的结果。
