Infectious complications in chronic graft-versus-host disease: a retrospective study of 145 recipients of allogeneic hematopoietic stem cell transplantation with reduced- and conventional-intensity conditioning regimens

Transpl Infect Dis. 2008 Jul;10(4):252-9. doi: 10.1111/j.1399-3062.2007.00291.x. Epub 2008 Jan 9.

Abstract

To assess infectious complications associated with chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation (HSCT) with reduced- and conventional-intensity conditioning regimens (RIC, n=91; CIC, n=54, respectively), we retrospectively analyzed data from 145 consecutive patients with cGVHD after allogeneic HSCT from a human leukocyte antigen-matched related or unrelated donor. In the present retrospective analysis, 57% (83/145) of patients with cGVHD developed infections, with a mortality rate of 27% (22/83). The incidences of bacteremia (n=28), central venous catheter-related infections (n=11), bacterial pneumonia (n=4), invasive aspergillosis (n=7), and adenoviral hemorrhagic cystitis (n=8) were significantly higher in patients with prednisolone dose >or=1 mg/kg at the time of diagnosis of cGVHD. The present results suggest that infections associated with cGVHD, especially after high-dose prednisolone, are predictive of poor outcome regardless of whether the patient received RIC or CIC.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aspergillosis / epidemiology
  • Aspergillosis / microbiology
  • Bacteremia / epidemiology
  • Bacteremia / microbiology
  • Busulfan / administration & dosage
  • Catheterization, Central Venous / adverse effects
  • Chronic Disease
  • Communicable Diseases* / complications
  • Communicable Diseases* / epidemiology
  • Communicable Diseases* / etiology
  • Communicable Diseases* / mortality
  • Cyclophosphamide / administration & dosage
  • Female
  • Graft vs Host Disease / complications*
  • Graft vs Host Disease / epidemiology
  • Graft vs Host Disease / prevention & control
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Pneumonia, Bacterial / epidemiology
  • Pneumonia, Bacterial / microbiology
  • Transplantation Conditioning* / methods
  • Transplantation, Homologous / adverse effects*
  • Treatment Outcome
  • Vidarabine / administration & dosage
  • Vidarabine / analogs & derivatives
  • Whole-Body Irradiation

Substances

  • Cyclophosphamide
  • Vidarabine
  • Busulfan
  • fludarabine