Vigilance Needed to Prevent Late-Stage Infections After Allogeneic Hematopoietic Cell Transplant

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A history of chronic graft-vs-host disease was a risk factor for the development of late-stage fatal infections.
A history of chronic graft-vs-host disease was a risk factor for the development of late-stage fatal infections.

Late-stage fatal infections are responsible for approximately 1 in 3 deaths in pediatric and adult patients who have survived for 2 years after undergoing allogeneic hematopoietic cell transplant (HCT).

Researchers analyzed the incidence and types of late fatal infections, as well as risk factors contributing to these infections, in 10,336 adult and 5088 pediatric patients surviving at least 2 years after first HCT without relapse. Data were reported to the Center for International Blood and Marrow Transplant Research and published in Biology of Blood and Marrow Transportation.

Of the 2245 adult and 377 pediatric patients in the study population who died, infections were a primary or contributing cause of death in 31% of adults (687 patients) and 29% of children (110 patients). The cumulative incidence of late fatal infections at 12 years post-HCT was 6.4% (95% CI 5.8-7.0) in adults compared with 1.8% (95% CI 1.4-2.3) in children (P <.001).

The 2 biggest risk factors for developing late fatal infections in adult patients were older age and a history of chronic graft-vs-host disease (GVHD) with ongoing immunosuppression. The 3 biggest risk factors for developing late fatal infections in pediatric patients were a history of chronic GVHD with or without ongoing immunosuppression, diagnosis of inherited abnormalities in erythrocyte function compared with diagnosis of acute myeloid leukemia, and being older than 10 years.

The authors concluded that continued vigilance for late infections after HCT and treatment strategies that decrease the risk of developing chronic GVHD are critical for long-term treatment of adult and pediatric patients.

Reference

1. Norkin M, Shaw BE, Brazauskas R, et al. Characteristics of late fatal infections after allogeneic hematopoietic cell transplant [published October 1, 2018]. Biol Blood Marrow Transplant. doi: 10.1016/j.bbmt.2018.09.031

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