Diem-Lan Vu1, Julie-Anne Dayer1, Stavroula Masouridi-Levrat2,3, Christophe Combescure4, Elsa Boely5, Nina Khanna6, Nicolas J Mueller7, Martina Kleber8, Michael Medinger8, Joerg Halter8, Jakob Passweg8, Antonia M Müller9, Urs Schanz9, Yves Chalandon2,3, Dionysios Neofytos1, Christian van Delden3,5, Laurent Kaiser1,3. 1. Division of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland. 2. Division of Hematology, University of Geneva Hospitals, Geneva, Switzerland. 3. University of Geneva Medical School, Geneva, Switzerland. 4. Clinical Research Centre, University of Geneva Hospitals, Geneva, Switzerland. 5. Transplant Infectious Diseases Unit, University of Geneva Hospitals, Geneva, Switzerland. 6. Division of Infectious Diseases, University of Basel Hospital, Basel, Switzerland. 7. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zürich, Switzerland. 8. Division of Hematology, University of Basel Hospital, Basel, Switzerland. 9. Division of Medical Oncology and Hematology, University of Zurich Hospital, Zürich, Switzerland.
Abstract
BACKGROUND: Infections are an important complication after allogeneic hematopoietic cell transplantation (allo-HCT). The present study aimed at determining the landscape of infections occurring in a large cohort of allo-HCT patients, as well as associated risk factors for infections and for one-year non-relapse mortality. METHODS: This is a retrospective cohort study using STCS and EBMT databases to assess the one-year incidence rate of infection, as well as risk factors for infections and for one-year non-relapse mortality among adult allo-HCT patients transplanted between 2010 and 2014 in Switzerland. Univariable and multivariable quasi-Poisson and multivariable Cox regression models were used. RESULTS: Of 553 patients included, 486 had an infection with a global incidence rate of 3.66 infections per patient-year. Among a total of 1534 infections analyzed, viral infections were predominant (n = 1138, 74.2%), followed by bacterial (n = 343, 22.4%) and fungal (n = 53, 3.5%) infections. At one year, the cumulative incidence of relapse and non-relapse mortality was 26% and 16%, respectively. 195 (35.3%) of patients had at least one episode of severe graft-versus-host-disease (GvHD). A center effect was observed, and underlying disease, donor type, cytomegalovirus serological constellation, and GvHD were also associated with the incidence rate of infections. There was an increased risk for one-year non-relapse mortality associated with all pathogens, specifically within two months of infection, and this remained true beyond 2 months of a fungal infection. CONCLUSION: Despite advances to limit infections in this population, they still occur in most allo-HCT patients with a major impact on survival at 1 year.
BACKGROUND:Infections are an important complication after allogeneic hematopoietic cell transplantation (allo-HCT). The present study aimed at determining the landscape of infections occurring in a large cohort of allo-HCT patients, as well as associated risk factors for infections and for one-year non-relapse mortality. METHODS: This is a retrospective cohort study using STCS and EBMT databases to assess the one-year incidence rate of infection, as well as risk factors for infections and for one-year non-relapse mortality among adult allo-HCT patients transplanted between 2010 and 2014 in Switzerland. Univariable and multivariable quasi-Poisson and multivariable Cox regression models were used. RESULTS: Of 553 patients included, 486 had an infection with a global incidence rate of 3.66 infections per patient-year. Among a total of 1534 infections analyzed, viral infections were predominant (n = 1138, 74.2%), followed by bacterial (n = 343, 22.4%) and fungal (n = 53, 3.5%) infections. At one year, the cumulative incidence of relapse and non-relapse mortality was 26% and 16%, respectively. 195 (35.3%) of patients had at least one episode of severe graft-versus-host-disease (GvHD). A center effect was observed, and underlying disease, donor type, cytomegalovirus serological constellation, and GvHD were also associated with the incidence rate of infections. There was an increased risk for one-year non-relapse mortality associated with all pathogens, specifically within two months of infection, and this remained true beyond 2 months of a fungal infection. CONCLUSION: Despite advances to limit infections in this population, they still occur in most allo-HCT patients with a major impact on survival at 1 year.
Authors: L Kaiser; D L Vu; M C Zanella; S Cordey; F Laubscher; M Docquier; G Vieille; C Van Delden; V Braunersreuther; Mc Kee Ta; J A Lobrinus; S Masouridi-Levrat; Y Chalandon Journal: Microbiome Date: 2021-01-24 Impact factor: 14.650