Microbiologically documented infections after adult allogeneic hematopoietic cell transplantation: A 5‐year analysis within the Swiss Transplant Cohort study

• Published in: Transplant infectious disease 2020-08, Vol.22 (4), p.e13289-n/a
• Main Authors: Vu, Diem‐Lan, Dayer, Julie‐Anne, Masouridi‐Levrat, Stavroula, Combescure, Christophe, Boely, Elsa, Khanna, Nina, Mueller, Nicolas J., Kleber, Martina, Medinger, Michael, Halter, JOERG, Passweg, Jakob, Müller, Antonia M., Schanz, Urs, Chalandon, Yves, Neofytos, Dionysios, Delden, Christian, Kaiser, Laurent, Amico, Patrizia, Aubert, John‐David, Banz, Vanessa, Beldi, Guido, Benden, Christian, Berger, Christoph, Binet, Isabelle, Bochud, Pierre‐Yves, Branca, Sanda, Bucher, Heiner, Carell, Thierry, Catana, Emmanuelle, Geest, Sabina, Rougemont, Olivier, Dickenmann, Michael, Duchosal, Michel, Elkrief, Laure, Fehr, Thomas, Ferrari‐Lacraz, Sylvie, Garzoni, Christian, Soccal, Paola Gasche, Gaudet, Christophe, Giostra, Emiliano, Golshayan, Déla, Hadaya, Karine, Heim, Dominik, Hess, Christoph, Hillinger, Sven, Hirsch, Hans H, Hofbauer, Günther, Huynh‐Do, Uyen, Immer, Franz, Klaghofer, Richard, Koller, Michael, Laesser, Bettina, Lehmann, Roger, Lovis, Christian, Majno, Pietro, Manuel, Oriol, Marti, Hans‐Peter, Martin, Pierre Yves, Meylan, Pascal, Mohacsi, Paul, Morel, Philippe, Mueller, Ulrike, Mueller‐McKenna, Helen, Müller, Thomas, Müllhaupt, Beat, Pascual, Manuel, Posfay‐Barbe, Klara, Rick, Juliane, Roosnek, Eddy, Rosselet, Anne, Rothlin, Silvia, Ruschitzka, Frank, Schaub, Stefan, Schnyder, Aurelia, Seiler, Christian, Sprachta, Jan, Stampf, Susanne, Steiger, Jürg, Stirnimann, Guido, Toso, Christian, Venetz, Jean‐Pierre, Villard, Jean, Wick, Madeleine, Wilhelm, Markus, Yerly, Patrick
• Format: Article
• Language: English
• Subjects: allogeneic cell transplantation; Cohort analysis; Constellations; Cytomegalovirus; Fungi; Graft-versus-host reaction; infection; Infections; Mortality; Regression analysis; Regression models; Risk analysis; Risk factors; Stem cell transplantation; Transplantation; Transplants & implants; Viral infections
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.13289

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.