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Bone Marrow Transplant. 2019 Aug;54(8):1254-1265. doi: 10.1038/s41409-018-0401-4. Epub 2018 Dec 13.

Bacterial blood stream infections (BSIs), particularly post-engraftment BSIs, are associated with increased mortality after allogeneic hematopoietic cell transplantation.

Author information

1
Division of Hematology, Oncology and Cellular Therapy, Rush University, Chicago, IL, USA. Celalettin_Ustun@rush.edu.
2
Division of Infectious Disease and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
3
Infectious Diseases Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
4
CIBMTR© (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA.
5
Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
6
Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
7
Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
8
University of Miami, Miami, FL, USA.
9
Division of Pediatric Oncology/Hematology, Department of Pediatrics, Penn State Hershey Children's Hospital and College of Medicine, Hershey, PA, USA.
10
Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA, USA.
11
Medical College of Wisconsin, Milwaukee, WI, USA.
12
Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA.
13
Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
14
Tom Baker Cancer Center, Calgary, AL, Canada.
15
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
16
Division of Pediatric Allergy, Immunology & Bone Marrow Transplantation, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA.
17
Texas Transplant Institute, San Antonio, TX, USA.
18
Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
19
Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
20
Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden.
21
Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
22
Division of Pediatric Blood and Marrow Transplantation, Duke University Medical Center, Durham, NC, USA.
23
Houston Methodist Hospital, Houston, TX, USA.
24
Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
25
Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
26
Division of Hematology, Oncology and Cellular Therapy, Rush University, Chicago, IL, USA.
27
Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
28
Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA.
29
Blood and Marrow Transplant Program and Host Defense Program, Divisions of Hematology/Oncology/Bone Marrow Transplant and Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA.
30
Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
31
Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.
32
Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Abstract

We analyzed CIBMTR data to evaluate the incidence of non-relapse mortality (NRM) and association with overall survival (OS) for bacterial blood stream infections (BSIs) occurring within 100 days of alloHCT in 2 different phases: pre-/peri-engraftment (BSI very early phase, BSI-VEP) and BSI post-engraftment (BSI occurring between 2 weeks after engraftment and day 100, late early phase, BSI-LEP). Of the 7128 alloHCT patients, 2656 (37%) had ≥1 BSI by day 100. BSI-VEP, BSI-LEP, and BSI-Both constituted 56% (n = 1492), 31% (n = 824), and 13% (n = 340) of total BSI, respectively. Starting in 2009, we observed a gradual decline in BSI incidence through 2012 (61-48%). Patients with BSI-VEP were more likely to receive a myeloablative conditioning (MAC) regimen with total body irradiation (TBI). NRM was significantly higher in patients with any BSI (RR 1.82 95% CI 1.63-2.04 for BSI-VEP, RR 2.46, 95% CI 2.05-2.96 for BSI-LEP, and RR 2.29, 95% CI 1.87-2.81 for BSI-Both) compared with those without BSI. OS was significantly lower in patients with any BSI compared with patients without BSI (RR 1.36, 95% CI 1.26-1.47 for BSI-VEP; RR 1.83, 95% CI 1.58-2.12 for BSI-LEP: RR 1.66, 95% CI 1.43-1.94 for BSI-Both). BSIs within day 100 after alloHCT are common and remain a risk factor for mortality.

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