Journal
BLOOD ADVANCES
Volume 3, Issue 17, Pages 2525-2536Publisher
AMER SOC HEMATOLOGY
DOI: 10.1182/bloodadvances.2019000226
Keywords
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Categories
Funding
- Public Health Service from National Cancer Institute [5U24CA076518]
- National Heart, Lung, and Blood Institute
- National Institute of Allergy and Infectious Diseases of the National Institutes of Health
- National Institues of Health, National Heart, Lung, and Blood Institute [4U10HL069294]
- National Cancer Institute
- Health Resources and Services Administration (Department of Health and Human Services) [HHSH250201200016C]
- Office of Naval Research [N00014-17-1-2388, N0014-17-1-2850]
- Actinium Pharmaceuticals, Inc.
- Amgen, Inc.
- Amneal Biosciences
- Angiocrine Bioscience, Inc.
- Astellas Pharma US
- Atara Biotherapeutics, Inc.
- Be the Match Foundation
- bluebird bio, Inc.
- Bristol-Myers Squibb Oncology
- Celgene Corporation
- Cerus Corporation
- Chimerix, Inc.
- Fred Hutchinson Cancer Research Center
- Gamida Cell Ltd.
- Gilead Sciences, Inc.
- HistoGenetics, Inc.
- Immucor
- Incyte Corporation
- Janssen Scientific Affairs, LLC
- Jazz Pharmaceuticals, Inc.
- Juno Therapeutics
- Karyopharm Therapeutics, Inc.
- Kite Pharma, Inc.
- medac GmbH
- MedImmune
- Medical College of Wisconsin
- Mediware
- Merck Co., Inc.
- Mesoblast
- MesoScale Diagnostics, Inc.
- Millennium
- Takeda Oncology Co.
- Miltenyi Biotec
- National Marrow Donor Program
- Neovii Biotech NA, Inc.
- Novartis Pharmaceuticals Corporation
- Otsuka Pharmaceutical Co, Ltd.-Japan
- PCORI
- Pfizer Inc.
- Pharmacyclics, LLC
- PIRCHE AG
- Sanofi Genzyme
- Seattle Genetics
- Shire
- Spectrum Pharmaceuticals, Inc.
- St. Baldrick's Foundation
- Sunesis Pharmaceuticals, Inc.
- Swedish Orphan Biovitrum, Inc.
- Takeda Oncology
- Telomere Diagnostics, Inc.
- University of Minnesota
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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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