Department of Hematology, Kitakyushu Municipal Medical Center, Japan.
Department of Infectious Diseases, Kitakyushu Municipal Medical Center, Japan.
Intern Med. 2023 Nov 15;62(22):3305-3316. doi: 10.2169/internalmedicine.1666-23. Epub 2023 Apr 7.
Objective Infections after a second hematopoietic stem cell transplantation (HSCT) occur commonly and are associated with high mortality. However, studies on bloodstream infection (BSI) after a second HSCT are lacking. We therefore evaluated the details of BSI after a second HSCT. Methods We retrospectively evaluated the incidence, etiology, risk factors, and outcomes of BSI after a second HSCT. Patients Fifty-two adult patients with hematological malignancies who underwent allogeneic HSCT, including cord blood transplantation (CBT; n=33), as the second transplantation were enrolled. The second transplantation was limited to allogeneic HSCT. Patients who underwent HSCT for graft failure were excluded. Results The median HSCT interval was 438 (range: 39-3,893) days. Overall, 31 (59.6%) patients received autologous HSCT as the first HSCT. The cumulative incidence of BSI was 40.4% at 100 days after the second HSCT, with Gram-positive bacteria accounting for the majority (30.8%) of pathogens. Overall, 92.0% of BSIs occurred during the pre-engraftment period, and Enterococcus faecium accounted for 29.6% of pathogens. On a multivariate analysis, CBT was most closely associated with pre-engraftment BSI after the second HSCT (hazard ratio: 3.43, 95% confidence interval: 1.05-11.23, p=0.042). The 1-year survival rate after the second HSCT was lower in patients with BSI than in patients without BSI (p=0.10). Conclusion BSI is common after a second HSCT, especially with CBT. During the pre-engraftment period, BSI caused by pathogens such as E. faecium should be anticipated and appropriately treated to improve transplant outcomes.
二次造血干细胞移植（HSCT）后常发生感染，且与高死亡率相关。然而，关于二次 HSCT 后血流感染（BSI）的研究较少。因此，我们评估了二次 HSCT 后 BSI 的详细情况。
我们回顾性评估了二次 HSCT 后 BSI 的发生率、病因、危险因素和转归。
52 例接受异基因 HSCT 的血液系统恶性肿瘤患者，包括脐带血移植（CBT；n=33），作为二次移植。二次移植仅限于异基因 HSCT。因移植物失败而接受 HSCT 的患者被排除在外。
HSCT 间隔中位数为 438（范围：39-3893）天。总体而言，31（59.6%）例患者接受自体 HSCT 作为首次 HSCT。二次 HSCT 后 100 天 BSI 的累积发生率为 40.4%，革兰阳性菌占多数（30.8%）。总体而言，92.0%的 BSI 发生于植入前期间，肠球菌属（粪肠球菌）占病原体的 29.6%。多因素分析显示，CBT 与二次 HSCT 后植入前 BSI 最密切相关（危险比：3.43，95%置信区间：1.05-11.23，p=0.042）。与无 BSI 的患者相比，二次 HSCT 后发生 BSI 的患者 1 年生存率较低（p=0.10）。
二次 HSCT 后 BSI 很常见，尤其是采用 CBT 时。在植入前期间，应预计到由粪肠球菌等病原体引起的 BSI，并进行适当治疗，以改善移植结局。
