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Increased overall and bacterial infections following myeloablative allogeneic HCT for patients with AML in CR1
- Ustun, Celalettin;
- Kim, Soyoung;
- Chen, Min;
- Beitinjaneh, Amer M;
- Brown, Valerie I;
- Dahi, Parastoo B;
- Daly, Andrew;
- Diaz, Miguel Angel;
- Freytes, Cesar O;
- Ganguly, Siddhartha;
- Hashmi, Shahrukh;
- Hildebrandt, Gerhard C;
- Lazarus, Hillard M;
- Nishihori, Taiga;
- Olsson, Richard F;
- Page, Kristin M;
- Papanicolaou, Genovefa;
- Saad, Ayman;
- Seo, Sachiko;
- William, Basem M;
- Wingard, John R;
- Wirk, Baldeep;
- Yared, Jean A;
- Perales, Miguel-Angel;
- Auletta, Jeffery J;
- Komanduri, Krishna V;
- Lindemans, Caroline A;
- Riches, Marcie L
- et al.
Published Web Location
https://doi.org/10.1182/bloodadvances.2019000226Abstract
Presumably, reduced-intensity/nonmyeloablative conditioning (RIC/NMA) for allogeneic hematopoietic cell transplantation (alloHCT) results in reduced infections compared with myeloablative conditioning (MAC) regimens; however, published evidence is limited. In this Center for International Blood and Marrow Transplant Research study, 1755 patients (aged ≥40 years) with acute myeloid leukemia in first complete remission were evaluated for infections occurring within 100 days after T-cell replete alloHCT. Patients receiving RIC/NMA (n = 777) compared with those receiving MAC (n = 978) were older and underwent transplantation more recently; however, the groups were similar regarding Karnofsky performance score, HCT-comorbidity index, and cytogenetic risk. One or more infections occurred in 1045 (59.5%) patients (MAC, 595 [61%]; RIC/NMA, 450 [58%]; P = .21) by day 100. The median time to initial infection after MAC conditioning occurred earlier (MAC, 15 days [range, <1-99 days]; RIC/NMA, 21 days [range, <1-100 days]; P < .001). Patients receiving MAC were more likely to experience at least 1 bacterial infection by day 100 (MAC, 46% [95% confidence interval (CI), 43-49]; RIC/NMA, 37% [95% CI, 34-41]; P = .0004), whereas at least a single viral infection was more prevalent in the RIC/NMA cohort (MAC, 34% [95% CI, 31-37]; RIC/NMA, 39% [95% CI, 36-42]; P = .046). MAC remained a risk factor for bacterial infections in multivariable analysis (relative risk, 1.44; 95% CI, 1.23-1.67; P < .0001). Moreover, the rate of any infection per patient-days at risk in the first 100 days (infection density) after alloHCT was greater for the MAC cohort (1.21; 95% CI, 1.11-1.32; P < .0001). RIC/NMA was associated with reduced infections, especially bacterial infections, in the first 100 days after alloHCT.
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