Wallis Whitney, Gulbis Alison M, Wang Tao, Lee Catherine J, Sharma Akshay, Williams Kirsten M, Nishihori Taiga, Prestidge Tim, Gowda Lohith, Byrne Michael, Krem Maxwell M, MacMillan Margaret L, Kitko Carrie L, Pidala Joseph, Spellman Stephen R, Lee Stephanie J, Alousi Amin M
The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
Bone Marrow Transplant. 2025 Jan;60(1):52-57. doi: 10.1038/s41409-024-02426-9. Epub 2024 Oct 18.
Bacterial bloodstream infections (BSI) can be a substantial contributor to complications of GVHD treatment. The aim of this study was to determine the risk for BSI from neutrophil engraftment through day 100 post transplant in patients with acute GVHD (AGVHD) based on organ involvement and severity. Patients (n = 4064) who underwent an allogeneic hematopoietic stem cell transplant (HCT) reported to the CIBMTR registry were analyzed. Grade II-IV AGVHD occurred in 1607 (39.5%) patients and was associated with a greater day-100 incidence of post engraftment BSI than with grade 0/I (24.9 vs. 15.3%). Patients with grade III/IV AGVHD had the highest BSI risk (HR 2.45; 95% CI 1.99-3.0; p < 0.0001). Lower GI involvement increased BSI risk (HR 1.54; 95% CI 1.17-2.02; p = 0.0019). BSI post-engraftment through day 100 was associated with worse survival (HR 1.64, 95% CI 1.43-1.87; p < 0.001) and higher non-relapse mortality (NRM), (HR 2.22; 95% CI 1.91-2.59; p < 0.001). Those with stage III/IV GI involvement are at highest risk for BSI. Future studies evaluating novel methods for preventing BSI in these high risk populations are needed to reduce mortality associated with AGVHD.
细菌血流感染（BSI）可能是移植物抗宿主病（GVHD）治疗并发症的一个重要促成因素。本研究的目的是根据器官受累情况和严重程度，确定急性移植物抗宿主病（AGVHD）患者从嗜中性粒细胞植入到移植后100天发生BSI的风险。对向CIBMTR登记处报告的接受异基因造血干细胞移植（HCT）的患者（n = 4064）进行了分析。1607例（39.5%）患者发生II-IV级AGVHD，与0/I级相比，植入后100天BSI的发生率更高（24.9%对15.3%）。III/IV级AGVHD患者的BSI风险最高（风险比[HR] 2.45；95%置信区间[CI] 1.99-3.0；p < 0.0001）。下消化道受累会增加BSI风险（HR 1.54；95% CI 1.17-2.02；p = 0.0019）。移植后至100天的BSI与较差的生存率（HR 1.64，95% CI 1.43-1.87；p < 0.001）和较高的非复发死亡率（NRM）相关（HR 2.22；95% CI 1.91-2.59；p < 0.001）。III/IV期胃肠道受累者发生BSI的风险最高。需要开展未来研究，评估在这些高危人群中预防BSI的新方法，以降低与AGVHD相关的死亡率。
