Microbiologically documented infections after adult allogeneic hematopoietic cell transplantation: A 5-year analysis within the Swiss Transplant Cohort study.
Adolescent
Adult
Aged
Bacterial Infections
/ epidemiology
Databases, Factual
Female
Hematopoietic Stem Cell Transplantation
/ adverse effects
Humans
Male
Middle Aged
Mycoses
/ epidemiology
Proportional Hazards Models
Recurrence
Retrospective Studies
Risk Factors
Switzerland
Time Factors
Transplantation, Homologous
/ adverse effects
Virus Diseases
/ epidemiology
Young Adult
allogeneic cell transplantation
infection
mortality
Journal
Transplant infectious disease : an official journal of the Transplantation Society
ISSN: 1399-3062
Titre abrégé: Transpl Infect Dis
Pays: Denmark
ID NLM: 100883688
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
29
10
2019
revised:
07
03
2020
accepted:
31
03
2020
pubmed:
12
4
2020
medline:
8
6
2021
entrez:
12
4
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
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.
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13289Subventions
Organisme : Swiss Transplant Cohort Study
Organisme : Swiss University Hospitals (G15)
Organisme : Swiss National Science Foundation
ID : 33CS30_134267
Pays : Switzerland
Organisme : Swiss National Science Foundation
ID : 33CS30_148512
Pays : Switzerland
Investigateurs
Patrizia Amico
(P)
John-David Aubert
(JD)
Vanessa Banz
(V)
Guido Beldi
(G)
Christian Benden
(C)
Christoph Berger
(C)
Isabelle Binet
(I)
Pierre-Yves Bochud
(PY)
Sanda Branca
(S)
Heiner Bucher
(H)
Thierry Carell
(T)
Emmanuelle Catana
(E)
Sabina Geest
(S)
Olivier Rougemont
(O)
Michael Dickenmann
(M)
Michel Duchosal
(M)
Laure Elkrief
(L)
Thomas Fehr
(T)
Sylvie Ferrari-Lacraz
(S)
Christian Garzoni
(C)
Paola Gasche Soccal
(PG)
Christophe Gaudet
(C)
Emiliano Giostra
(E)
Déla Golshayan
(D)
Karine Hadaya
(K)
Dominik Heim
(D)
Christoph Hess
(C)
Sven Hillinger
(S)
Hans H Hirsch
(HH)
Günther Hofbauer
(G)
Uyen Huynh-Do
(U)
Franz Immer
(F)
Richard Klaghofer
(R)
Michael Koller
(M)
Bettina Laesser
(B)
Roger Lehmann
(R)
Christian Lovis
(C)
Pietro Majno
(P)
Oriol Manuel
(O)
Hans-Peter Marti
(HP)
Pierre Yves Martin
(PY)
Pascal Meylan
(P)
Paul Mohacsi
(P)
Philippe Morel
(P)
Ulrike Mueller
(U)
Helen Mueller-McKenna
(H)
Thomas Müller
(T)
Beat Müllhaupt
(B)
Manuel Pascual
(M)
Klara Posfay-Barbe
(K)
Juliane Rick
(J)
Eddy Roosnek
(E)
Anne Rosselet
(A)
Silvia Rothlin
(S)
Frank Ruschitzka
(F)
Stefan Schaub
(S)
Aurelia Schnyder
(A)
Christian Seiler
(C)
Jan Sprachta
(J)
Susanne Stampf
(S)
Jürg Steiger
(J)
Guido Stirnimann
(G)
Christian Toso
(C)
Jean-Pierre Venetz
(JP)
Jean Villard
(J)
Madeleine Wick
(M)
Markus Wilhelm
(M)
Patrick Yerly
(P)
Informations de copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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